磁共振成像在喉癌诊断中的应用价值

目的：探讨磁共振成像（MRI）在喉癌诊断中的应用价值。方法回顾性分析26例喉癌患者的MRI表现。结果26例喉癌中声门型l5例（57.7％）,声门上型7例（26.9％）,跨声门型4例（15.4％）,无声门下型。MRI表现为声带局部侵润、增厚,喉内软组织肿块、贯穿声门及周围组织浸润,颈部淋巴结转移。结论 MRI检查在诊断喉癌过程中能清晰准确并直观的反应癌肿侵犯的范围与邻近扩散情况,对于喉癌的早期诊断、分期及治疗具有重要意义。     

CO2激光手术治疗早期声门型喉癌的临床评价

目的：探讨显微喉镜下CO2激光手术治疗早期声门型喉癌的疗效。方法：回顾性分析2005年2月-2008年6月在中山大学肿瘤防治中心接受CO2激光手术治疗的105例早期声门型喉癌患者的临床资料,其中Tis13例,T1a55例,T1b20例,陀17例,分析其近、远期疗效及复发情况。结果：全部患者CO2激光手术均成功,随访18～52个月,全部患者存活,喉功能保留率为95．2％（100／105）,单用激光手术治疗局部控制率为86．7％（91／105）,局部复发率为12．3％（13／105）,前联合受累者复发率占30％（9／30）。结论：CO2激光手术是早期声门型喉癌有效而微创的治疗手段。     

二氧化碳激光微创治疗早期声门型喉癌疗效分析

目的总结二氧化碳激光手术治疗声门型喉癌的临床治疗效果。方法对2002年4月至2008年4月安徽省立医院耳鼻咽喉头颈外科激光手术治疗的89例声门型喉癌进行临床分析。89例中T1 a病变55例,T1b病变18例,T2病变16例,累及前联合者15例。术后随诊6~72个月。结果89例支撑喉镜下CO2激光术后10例局部复发,复发率为11.2%(10/89)。T1 a复发率5.4%(3/55),T1b复发率16.6%(3/18),T2复发率25.0%(4/16),组间差异有显著性(χ2=4.839,P<0.05)。病变侵犯前联合复发率13.3%(2/15),病变未侵犯前联合复发率10.8%(8/74),两组间差异无统计学意义(χ2=0.696,P>0.05)。89例激光手术治疗的患者,86例存活,死亡3例。结论二氧化碳激光手术治疗早期声门型喉癌疗效可靠,喉功能保全好,是一种值得推广的治疗方式。     

经电子支气管镜孔道注射博来霉素治疗咽喉部血管瘤的疗效观察

目的探讨经电子支气管镜孔道局部注射博来霉素治疗咽喉部血管瘤的临床疗效。方法对该科2010年1月-2017年6月收治的有完整资料的34例咽喉部血管瘤患者进行回顾性分析。所有患者均经电子支气管镜孔道进行博来霉素的局部注射治疗,最多注射6次,最少2次,平均4.5次,以电子支气管镜检查瘤体大小变化作为疗效观察的主要评价指标。结果所有患者均表面麻醉下完成手术,痊愈28例(82.4%),有效6例(17.6%),总有效率100.0%。1例因为血管瘤瘤体大,行预防性气管切开,1个月后顺利拔管。所有患者术后复查血常规及胸片,未出现白细胞减少及肺纤维化等不良反应。结论经电子支气管镜孔道注射博来霉素治疗咽喉部血管瘤效果显著,具有创伤小,安全性高、可反复治疗和对喉功能保留好等优点,值得在临床上推广应用。     

喉鳞状细胞癌全喉切除术后复发和颈部转移

目的：探讨喉鳞状细胞癌全喉切除术后的复发和颈淋巴结转移特点。方法：回顾分析108例因喉鳞状细胞癌行全喉切除手术的病例资料。结果；108例喉鳞状细胞癌患者有48例出现颈淋巴结转移，有8例局部复发，局部复发者预后差。48例出现颈淋巴结转移者中，有18例颈淋巴结转移发生于全喉切除手术之前，30例颈淋巴结转移发生于全喉切除手术之后。声门上型喉鳞状细胞癌比声门型容易发生颈淋巴结转移（P〈0.01），T3和T4期患者比T2期患者容易发生颈淋巴结转移（P〈0．01）。结论：颈淋巴结转移是喉鳞状细胞癌患者的常见现象，外科医师应警惕喉鳞状细胞癌颈淋巴结的高转移特性，并制定合适的治疗方案。对晚期和声门上型喉鳞状细胞癌应进行密切的术后随访。     

电子喉镜在咽喉部肿物活检中的临床应用及病理分析*

目的探讨电子喉镜下对咽喉部肿物活检的临床应用,并分析病理结果。方法回顾性分析声带白斑、喉部肿瘤、下咽部肿瘤3类咽喉部常见肿物的患者资料共199例,均在门诊电子喉镜下表面麻醉后进行组织活检,送病理检查。分析3类病变患者的性别、年龄分布及病理意义。评价电子喉镜下活检咽喉部肿物的价值和意义。结果 3类病变的男性患者均明显多于女性,声带白斑患者年龄段分布明显比喉部和下咽部肿瘤患者年轻化(P0.05)。67例声带白斑病理:慢性炎伴鳞状上皮增生35例(52.24%),低度上皮内瘤变17例(25.37%),高度上皮内瘤变12例(17.91%),可疑浸润癌2例(2.99%),浸润癌1例(1.49%)。97例喉部肿瘤病理:高度上皮内瘤变/原位癌35例(36.08%),可疑浸润癌14例(14.43%),浸润癌48例(49.48%)。35例下咽部肿瘤病理:高度上皮内瘤变/原位癌6例(17.14%,),可疑浸润癌4例(11.43%),浸润癌25例(71.43%)。结论电子喉镜下表面麻醉活检咽喉部肿物,麻醉风险低,操作灵活,明显减少了患者经济成本,为后续治疗提供了病理学依据,是方便、快捷、有效的活检方法。     

Laryngeal saccular cyst

We present a case report of a 66-year-old female with a laryngeal saccular cyst that was treated endoscopically. Although this is an uncommon laryngeal anomaly, when it is recognized and managed appropriately early in the course of its presentation patient complications and morbidity can be avoided. The laryngeal saccular cyst can mimic or be associated with other, more serious, laryngeal pathology, including carcinoma of the larynx. Because of the known association between carcinoma of the larynx and laryngeal saccular cysts, these lesions should be fully evaluated endoscopically and surgically excised. Direct microlaryngoscopy with the use of the operating microscope is a safe and effective method for the treatment of laryngeal saccular cysts.     

CT 仿真喉镜的临床应用

目的 探讨ＣＴ仿真间成像在喉科的临床应用价值。方法 对５名健康者、１６例喉癌、５例声带及披裂息肉、４例乳头状瘤、１例披裂慢性炎病、１例喉气囊肿、１例喉旁囊肿、１例喉切割伤成形术后、１例喉癌术后共３５例患者,行螺旋ＣＴ扫描后经软件处理,获得仿真喉镜图像,所有病例均与喉镜和手术所见对照分析。结果 ＣＴ 仿真内镜显示喉内正常解剖与纤维喉镜一致;显示喉黏膜病变敏感性７４．３％;显示病变范围优于纤维喉镜;对     

高分辨力超声在声门上型喉癌诊断中的临床意义

目的探讨超声在声门上型喉癌诊断中的临床价值。方法22例经喉镜和手术病理证实的声门上型喉癌患者,术前采用超声检查,结果与喉镜、手术病理结果对比分析。结果声门上型喉癌22例,声像图上显示20例,显示率90.9%。肿瘤在声像图上回声特点分两型,I型局限性肿块型,占70%(14/20),声像图为低回声,肿物的轮廓界线显示清晰;II型溃疡型占30%(6/20)。22例中侵犯前联合5例,伴会厌前间隙(per-epiglotticspace,PEF)和/或甲状软骨侵犯者3例。声带活动显示率90.9%。结论高分辨力超声能显示声门上型喉癌的肿块特点,判断会厌前间隙、前联合和甲状软骨的侵犯程度,有助于术前的准确分期。     

Carcinoma in situ of the vulva: 24 years' experience in southwest Florida

We retrospectively studied 125 patients treated for carcinoma in situ of the vulva from 1961 through 1984, with follow-up ranging from one to 24 years. Patients' ages ranged from 24 to 90 years, with a mean age of 53 years. Multifocal disease was more common in women under age 40. Pruritus was the most common complaint, but 60% of the patients were asymptomatic. Twenty-five patients (20%) had other associated malignancies: carcinoma in situ of the cervix in ten patients, invasive carcinoma of the cervix in six, multifocal carcinoma in situ involving vulva, vagina, and cervix in five, vaginal carcinoma in situ in two, and endometrial carcinoma in two. Sixty-five patients were treated primarily with wide excision, 45 with total vulvectomy, seven with "subtotal" vulvectomy, three with skinning vulvectomy, and three with vulvectomy and bilateral groin node dissection; two patients refused treatment. Fifteen patients had a recurrence--recurrent carcinoma in situ in ten, and invasive carcinoma of the vulva in five. Whether the patient had had total vulvectomy or a lesser procedure appeared to make no difference in the recurrence rate. Thus a well planned excision of vulvar carcinoma in situ appears to be the treatment of choice. All recurrences were in patients over age 40, so although the lesion is histopathologically identical in the younger patients, its biologic behavior seems to be more benign. Since it is possible, however, that invasive disease will ultimately develop in some of the younger patients, careful follow-up is still required.     

Prescribed and Measured Dose Differences for an AP-PA TBI Protocol with Compensation Filter and Ergonomic Patient Support

IntroductionA treatment scheme is presented for clinical applications of total body radiation using 6 MV photons.MethodsThe two-field technique, anteroposterior (AP) and posteroanterior (PA), was applied. In vivo dose verification with TLD-100 dosimeters was developed during the first treatment sessions. Dosimetry was performed in several anatomical regions such as head, shoulder, thorax, abdomen, hip, thigh, knee, and ankle in 13 patients as preconditioning for bone marrow transplantation. A prescribed dose of 100 cGy was considered at the level of the patient's coronal plane. Values with least differences between measured and prescribed dose were obtained for the shoulder.ResultsStandard deviation percentages of 0.3% and 2.6% were recorded between these doses for AP and PA, respectively. There were larger differences for other contours. In general, a measured dose less than the prescribed dose was observed in all the contours.ConclusionDifferences between prescribed and measured doses showed in this study can contribute to a required understanding about the accurate doses in AP-PA total body irradiation (TBI) treatments.     

Squamous cell carcinoma of the glottic larynx: a review emphasizing the University of Florida philosophy

BACKGROUND: Squamous cell carcinoma of the glottic larynx is strongly related to cigarette smoking and excessive ethanol intake. It is the most common head and neck cancer other than skin cancer. METHODS: We reviewed pertinent literature relative to etiology, epidemiology, and treatment results, with emphasis on the treatment philosophy at the University of Florida. RESULTS: The goals of treatment are cure and retention of a functional larynx. The probability of achieving both goals is high for patients with early disease. In contrast, a significant proportion of patients with advanced disease may be cured but must have a total laryngectomy as part of the treatment. CONCLUSIONS: Treatment options are influenced by the extent of disease and patient preference. Options include transoral laser resection, open partial laryngectomy, radiation therapy, and total laryngectomy. Adjuvant chemotherapy may have a role in advanced disease.     

Majer-Piquet手术治疗声带癌及其相关问题

目的 :探讨Majer -Piquet手术治疗声门型喉癌的相关问题。 方法 :应用Majer -Piquet术式进行治疗。 结果 :术后 9～ 18d(平均 14d)拔除气管导管 ;术后第 10～ 2 5d(平均 15d)拔除鼻饲管 ,术后的发音情况令人满意。结论 :Majer -Piquet手术是一种治疗T1 、T2 和部分T3声门型喉癌有效术式 ,而且能较满意地保留喉功能 ,提高患者的生存质量     

喉癌喉部分切除术中切缘病理检查的意义

目的 探讨喉癌喉部分切除术中切缘冷冻切片病理检查的临床意义。方法 以我院2000年1月～2003年10月间60例喉部分切除的喉癌声门型病人为观察对象;全部病例术前病理诊断为鳞状细胞癌。行喉裂开患侧声带、室带切除17例,行垂直半喉切除40例,行垂直半喉加额侧切除3例,同期行颈淋巴结清扫11例。术中在距肿瘤边缘3、5mm切缘处分别选多点切取组织600份标本行快速冷冻切片病理检查。结果 肿瘤切除后,距肿瘤3mm处切取的标本冷冻切片发现上切缘累及者2例,下切缘累及者1例,健侧声带前端累及者3例。距肿瘤5mm处切取的标本均无癌残留。两组之间比较差异有显著性（χ^2=6．06,P〈0．05）。随访5年生存率为76．7％。结论 在喉癌病人手术中,多点切取切缘快速冷冻切片病理检查指导喉部分切除,可以保证在彻底切除肿瘤的基础上最大程度地保留和重建病人喉的功能。手术切除范围至少应以包括距肿瘤边界5mm以内的癌旁组织作为安全切缘的参考标准是较为适宜的。     

早期声门型喉癌的治疗选择:放疗或手术治疗?

目的探讨早期声门型喉癌的首选治疗方法。方法对1例早期声门型喉癌的诊疗过程进行回顾性分析。结果本例因声音嘶哑在外院就诊诊断为声门型喉癌(T1N0M0),于全麻下行支撑喉镜下CO2激光辅助声带切除术,术后予根治性放疗,放疗后因呼吸困难而行气管切开术,声带切除术后10个月出现痰中带血,时有烂肉样组织咳出而转我院。行正电子发射型计算机断层扫描(PET-CT)排除喉癌复发,考虑为放疗后喉坏死,后因咯血加重,于声带切除术后11个月在全麻下行喉全切除术,术中见喉内组织大面积坏死,术后伤口愈合差,坏死形成咽瘘,喉全切除术后1个月因坏死累及颈部血管出现大出血死亡。结论支撑喉镜下CO2激光治疗和放疗是目前临床治疗早期声门型喉癌的主要方法,前者为首选治疗方法,两者不必联合应用,因联合治疗可增加并发症发生率。     

体部伽玛刀联合化疗治疗局部晚期非小细胞型肺癌疗效观察

目的 观察体部伽玛刀联合化疗治疗不能手术或拒绝手术的局部晚期非小细胞肺癌(Non-small Cell Lung Cancer,NSCLC)的疗效和副反应.方法 将2006年8月到2009年2月本院治疗的110例符合入选条件的局部晚期NSCLC患者,随机分成治疗组和对照组.治疗组:体部伽玛刀加化疗.体部伽玛刀治疗:单次处方剂量50%等剂量曲线为350cGy～400cGy,1次/d,共14次,总剂量49Gy～56Gy.化疗:采用紫杉醇+顺铂方案,于伽玛刀治疗后1周左右开始,共4个周期.对照组:常规放射治疗加化疗.采用60Co体外照射,放射剂量为50Gy～54Gy,180cGy～200cGy/次,5次/周,5～6周完成.化疗方案同治疗组.结果 治疗组:有效率为81.94%,1年、2年生存率分别为65.28%、47.22%,放射性肺炎发生率3.57%.对照组:有效率为63.16%,1年、2年生存率分别为39.47%、23.68%,放射性肺炎发生率16.67%.差异有统计学意义.结论 体部伽玛刀联合化疗对不能手术或拒绝手术的局部晚期NSCLC有效,毒副作用轻微.     

低剂量胸部CT与癌胚抗原、Cyfra21-1水平在早期肺癌检查中的价值

目的  探讨低剂量胸部CT扫描与癌胚抗原（CEA）、细胞角蛋白19片段抗原（Cyfra21-1）在早期肺癌检查中的价值。 方法  选取2019年1月~2021年1月在我院就诊的肺部亚实性结节患者108例,均给予低剂量CT扫描,经病理确诊为早期肺癌患者76例（其中原位癌34例,微浸润性癌22例,浸润性癌20例）,非肺癌患者32例,比较肺癌和非肺癌患者血清CEA、Cyfra21-1水平差异,分析CT联合血清CEA、Cyfra21-1诊断早期肺癌的价值。 结果  肺癌患者血清CEA、Cyfra21-1明显高于非肺癌患者（P < 0.05）;CT联合血清CEA、Cyfra21-1诊断早期肺癌的敏感度和阴性预测值明显高于CT检查（P < 0.05）;浸润性癌病灶直径、CT值明显高于原位癌和微浸润性癌（P < 0.05）;原位癌、微浸润性癌和浸润性癌患者CEA、Cyfra21-1的差异无统计学意义（P>0.05）;病灶直径、CT值诊断浸润性癌的ROC曲线下面积分别为0.941和0.816（P < 0.05）,截断值分别为15.86 mm和-422.52 Hu,敏感度分别为90.00%和65.00%,特异性分别为91.10%和89.30%。 结论  低剂量胸部CT与CEA、Cyfra21-1水平在早期肺癌诊断中有较好的价值,同时病灶直径及CT值在鉴别浸润性癌中有一定应用价值。     

喉部正常结构及喉癌的三维超声成像研究

目的探讨喉部三维超声成像的可行性及其在喉癌诊断中的价值。 方法对85例正常人进行喉部三维重建，所获图像由3人进行评议；对46例喉癌进行三维重建，并与术中所见比较，测得肿瘤血管指数（Ⅵ）与肿瘤N分期进行相关性分析。 结果被评为优良的三维图像分别为92．900、91．8％和90．600，不同评议者之间的评议结果有较好的一致性（Kappa值为0．833和0．794）；3例喉癌三维超声提供了二维超声所未能提示的空间信息；Ⅵ与N分期呈正相关（r=0．603，P〈0．001）。 结论三维超声可在喉部应用，三维立体图像对喉癌与毗邻组织结构的关系能提供更丰富的信息，Ⅵ有望成为预测喉癌淋巴结转移的重要参考因素。     

Laryngeal carcinoma in situ: a therapeutic dilemma

Two patients having laryngeal carcinoma in situ and seven having carcinoma in situ with microinvasion were treated with laser mucosal dissection of the vocal cords followed by vaporization of adjacent or deeper tissue that appeared abnormal through the operating microscope. In these early cases the depth of vaporization was usually superficial, so the normal architecture of the vocal cords was preserved. Five patients had recurrence or persistence of abnormal tissue; three required one additional laser treatment and two required two additional treatments. After follow-up periods ranging from 18 to 60 months, all patients are presently free of laryngeal abnormalities. No surgical procedures or radiation treatments were required. I believe transoral endoscopic laser treatment of laryngeal carcinoma in situ with or without microinvasion is both feasible and desirable.     

50例老年喉癌放射治疗疗效分析

目的：探讨单纯放疗与术后产疗对老年喉癌的疗效。方法：回顾性分析50例60岁以上老年喉癌的放射治疗效果。治疗方法：单纯放疗（剂量55-80Gy）和术后放疗（剂量50-75Gy)。随访率为92%,总的5年生存率为46%。结果：单纯放疗组（28例）和术后放疗组（22例）的5年生存率分别为39.2%和54.5%,临床I、Ⅱ、Ⅲ、Ⅳ期的5年生存率分别为81.8%,60%,38.9%,和9.1%。声门上型和声门型的5年生存率分别为34.4%和66.7%。有颈淋巴结转移的预后明显较无颈淋巴结转移的差。结论：早期声门癌单纯放疗可取得较高的5年生存率,对于Ⅱ、Ⅲ期喉癌,术后放疗能提高5年生存率,早期诊断及合理的治疗是提高老年喉癌生存期的关键。