我国头颈肿瘤外科的发展轨迹

头颈外科学作为临床医学的一个分支，４０年代首先在美国兴起，５０年代后期我国开始有头颈外科。虽然至今没有能够成立头颈肿瘤专业学术组织，但已经形成一支学术和技术水平较高的医疗队伍，有不少单位已经将科室改名为“耳鼻咽喉头颈外科”，治愈了数不尽的头颈肿瘤患...     

上颌骨翻转入路在头颈肿瘤手术中的应用

目的 评价上颌骨翻转入路在鼻咽咽旁颅底及颞下窝肿瘤手术中的应用。方法 回顾1995年1月—2005年1月中国医科院肿瘤医院头颈外科应用上颌骨翻转入路手术切除60例鼻咽、咽旁颅底及颞下窝肿瘤。51例原发于鼻咽或中颅底，9例原发颞下窝。13例良性肿瘤，47例为恶性肿瘤，其中28例术前接受过放射治疗。结果 全部病例无手术相关的较重的功能障碍及外观畸形。常见并发症是腭鼻漏12例及部分骨坏死2例，均见于鼻咽癌放疗后患者。用kaplan-Meier法计算恶性肿瘤累积5年生存率与无瘤生存率分别为76．4％和36．3％，良性肿瘤分别为100％和90％。结论 上颌骨翻转入路在处理头颈鼻咽、咽旁颅底及颞下窝肿瘤时被证明是良好的选择之一，该手术路径为这些区域提供良好的手术显露和肿瘤的安全切除，以最低限度的外貌和功能影响及较少的并发症而可获得好的治疗效果。     

迎接头颈肿瘤精准重建时代的来临

头颈肿瘤术后缺损的重建,对患者的外观和功能来说十分重要。随着现代精准外科学的发展,要求头颈外科医师要同时注重结构和功能重建的精准性。在结构重建中,局部轴型皮瓣的改良设计和穿支皮瓣的应用,使供区创伤趋于最小化,受区的结构和外观的重建更加与原来相近;虚拟现实技术、计算机辅助和3D打印技术的引入,使头颈部修复进一步提高了精准性。在功能重建中,吻合感觉神经和功能训练有助于感觉功能的恢复。目前,功能重建仍是未来头颈外科主要的努力方向。     

头颈肿瘤侵及前颅底的手术处理

本文复习文献，综述了头颈肿瘤侵及前颅底的手术处理原则；手术适应证；手术禁忌证；术前评估及处理；手术操作；修复手段及发症。认为以颅颌面联合入路处理侵及前颅底的头颈肿瘤具有：整块切除；术野清楚；可安全重建颅底等优点。     

游离组织移植在头颈肿瘤外科的应用

微血管吻合游离组织移植,可用于头颈部肿瘤切除后缺损的修复和重建,并使 其在形态和功能恢复方面有了长足的进步。近年来,随着游离组织移植在头颈肿瘤外科应用的日益广泛,新的手术方法和技术不断出现,我们现将相关的研究文献作一综述。     

游离股前外侧皮瓣修复头颈肿瘤术后缺损

目的探索供区功能和外观损伤更小的游离股前外侧(anterolateralthigh,ALT)皮瓣修复技术,运用于头颈肿瘤术后缺损。方法2003年12月—2005年5月中国医科院肿瘤医院头颈外科用于头颈部手术缺损修复的游离股前外侧皮瓣8例。头颈部肿瘤手术缺损按受区部位分为口咽侧壁3例,舌活动部2例,颊黏膜、舌根和颅底各1例。结果8例游离ALT皮瓣手术均获成功。供区伤口一期愈合,未发现切口裂开,下肢运动和感觉功能障碍等手术并发症。8例皮瓣的穿支血管类型均为肌皮穿支,皮瓣应用面积为(4~8)cm×(5~10)cm。手术时间5~10h,平均7h。皮瓣切取制作时间65~115min,平均80min。结论游离股前外侧皮瓣具有修复技术可靠、供区部位隐蔽和并发症少等优点,是头颈部缺损修复的理想皮瓣之一。     

头颈肿瘤术后并发肺栓塞

目的 提高对头颈肿瘤术后并发肺栓塞的诊断意识。方法 回顾性分析中国医学科学院中国协和医科大学肿瘤医院头颈外科1993－1999年头颈肿瘤手术后发生的5例严重急性肺栓塞患者的临床资料。结果 同期共行头颈肿瘤手术5801例，手术后死亡39例，发生严重急性肺栓塞5例，其中4例因漏诊、误诊未能给予及时正确的治疗，于2h内死亡，占同期术后死亡的10．3％（4／39）；仅1例得到正确诊断，经积极溶栓治疗存活。结论 急性肺栓塞是头颈肿瘤术后导致死亡的严重并发症；及时正确诊断与治疗可以挽救患者生命。     

Unusual presentation of head and neck neoplasm

We have a 67-year-old Caucasian male presenting with a (T4, N1b, M0) Stage III squamous cell carcinoma of the larynx. He subsequently underwent a total laryngectomy and right radical neck dissection. It was only determined by the pathology report that the cervical nodes in the neck specimen obtained the associated disease, Hodgkin's (mixed cellular lymphoma), rather than the expected well differentiated squamous cell carcinoma found in the larynx. Metastatic work-up was unrevealing. Reviewing the English literature fails to reveal a similar case report of squamous cell carcinoma of the larynx with Hodgkin's disease in the associated neck dissection. It was unfortunate that this patient died of a third pathology, cerebral hemorrhage, in the immediate post-op period.     

A new implant system in head and neck surgery]

Defects in the head and neck region following extensive tumor removal are sometimes difficult to reconstruct by local or free flaps. An epithesis is a recommended alternative in defects of the ear, the nose or the orbital region. Nevertheless problems may arise in the appropriate fixation of the epithesis. With the intermobile-cylinder-implant-system (IMZ), the epithesis is firmly fixed by means of osseointegration of the implants and an abutment in the area of the defect. The various steps of the operation and clinical applications are presented.     

Titanium miniplate fixation in head and neck cancer surgery]

OBJECTIVE: To evaluate the rigid fixation with miniplates in head and neck cancer surgery. METHOD: A consecutive series of 40 patients with head and neck tumor underwent rigid fixation with the Martin titanium miniplates system in a 6 years period. The miniplates were used to fix bone graft reconstruction following mandible resection (n = 14), mandibulotomies for oral and oropharyngeal surgical access (n = 12), maxilla swinging for nasopharyngeal access (n = 11) and other purposes (n = 3). Twenty-three of all cases(57.5%) received perioperative radiotherapy with average doses of 60Gy at the osteotomy site. RESULTS: Eleven of the 40 patient (22%) developed plate related complication which included 5 infections, 3 mandibular osteonecroses, 1 plate exposure, 1 screw loose and 1 nonunion. Complications were more likely to occur in patients with perioperative radiation than patients without (39.1% versus 11.8%, P = 0.079). Except one case, All the uncomplicated dentulous patients demonstrated stable and good occlusion. Oral feeding usually started on the 3-4th day after surgery. There was no need for intermaxillary fixation. CONCLUSION: The miniplate provided stable mandibular or maxillary fixation and accurate repositioning, eliminated the need for intermaxillary fixation. The malleability and versatility of miniplate make it unique in bone graft shaping for mandibular reconstruction. Complication seems to be related to perioperative radiotherapy. Median or paramedian mandibular osteotomy, which is non-radiated region in most radiotherapy cases, is advocated.     

励精图治任重道远——我国耳鼻咽喉头颈外科学发展60年

光阴荏苒、岁月如梭,我们的祖国迎来了60周年华诞.回顾60年的发展历程,社会主义建设事业成绩斐然!     

Methods for simulation of surgical interventions in head and neck surgery]

Preoperative evaluation of the operating site is essential in planning surgical procedures. The relationship of pathology to adjacent tissues and vital anatomical structures needs to be analyzed to determine the intraoperative procedures required. For this the surgeon mentally simulates the procedure planned. For complicated conditions or reconstructive surgery in extensive bony defects, surgery can be simulated with three-dimensional reconstruction on either a monitor screen or on an individually manufactured plastic model of the patient. For this purpose different procedures for 3 D representation and manipulation of tomographic image data have been developed in our departments and the technique of stereolithography used experimentally to create custom-made plastic model of patients. A computerized video image manipulator was also developed for simulation of aesthetic plastic surgical procedures.     

Bcl-2蛋白在头颈恶性肿瘤中的表达

为了探讨Ｂｃｌ－２蛋白在头颈恶性肿瘤发生、发展中的作用及与抑癌基因Ｐ５３的关系，采用免疫组化链霉力素生物素技术（ＬＳＡＢ法），对９０例头颈恶性肿瘤和２０例良必焦组织中的Ｂｃｌ－２，ｐ５３蛋白进行了检测。结果显示，４８．９％的头颈恶性肿瘤表达Ｂｃｌ－２蛋白，而２０例良性病变全部阴性。Ｂｃｌ－２在头颈鳞癌的表达率（５９．６％）明显高于腺癌（３４．８％）、未分化癌（３３．３％）和恶性淋巴瘤。在Ｐ５３阳性