儿童与青少年鼻咽癌分析

目的分析儿童与青少年鼻咽癌的流行病学、病理组织学特点、临床症状、诊断及误诊、治疗和预后。方法检索pubmed和万方、知网等相关资料库中有关儿童青少年鼻咽癌的病例报告及临床流行病学研究,并对此作出分析。结果儿童及青少年鼻咽癌患者发病率低,就诊时多为中晚期。常见首发症状为颈部肿块,鼻部症状(鼻塞、鼻出血),耳部症状(听力下降、耳鸣、耳闷),颅神经损害(颅神经麻痹、头痛)等。常被误诊为颈淋巴结炎、颈淋巴结结核、血管神经性头痛、中耳炎、鼻咽纤维血管瘤、腺样体肥大等。儿童青少年鼻咽癌对放疗敏感,其预后优于成人。结论儿童青少年鼻咽癌不易早期发现早期诊断,需要引起临床重视。     

鼻咽癌误诊的因素

为了解鼻咽癌漏诊或误诊的程度以及探讨引起鼻咽癌漏诊或误诊的有关因素，回顾性分析126例鼻咽癌患者临床资料。确诊时间为首次就诊到病理证实为鼻咽癌之间的时间，4周之内未被确诊就为误诊。确诊时间为1月者有IO6人，占85．7％，其中引例（72．2％）确诊时间为2周。误诊18例（1．3％），误诊时间在1．2月～25月之间，平均72月。将误诊因素分为1．2～25月之间，平均76月。5例初诊时未被疑诊为鼻咽癌，主要因为这些病人的症状和体征不典型，如颈、腋窝淋巴结肿大而被怀疑为淋巴瘤；咽旁脓肿，流脓涕伴面部疼痛而被误诊为鼻窦炎。7例初诊时临…     

鼻咽结核23例临床分析

报告鼻咽结核患者23例的临床资料,对其临床特点、诊断及鉴别诊断进行讨论。指出鼻咽结核与鼻咽癌极易误诊,应特别注意。     

隐匿性鼻咽癌误诊4例

鼻咽癌是耳鼻咽喉科常见的恶性肿瘤之一,鼻咽癌早发现、旱治疗至关重要.有些患者有鼻咽癌症状,但鼻咽部一直未能发现明显的原发病灶,或经过长期门诊随访未发现原发病灶而造成误诊.现将我科诊治的4例患者报告如下.     

妊娠期喉结核临床分析

目的　分析妊娠期喉结核的临床特点,减少误诊及不当治疗。方法　选取厦门市妇幼保健院2010~2018年收治的4例妊娠期喉结核患者进行回顾性分析,总结分析其临床资料、病情特点及诊疗情况。结果　2例初诊为喉肿物,2例为急性咽喉部炎症,予抗生素治疗无效,行喉镜检查诊断为喉肿物。2例孕早期患者适时结束妊娠,4例患者 均接受常规抗结核治疗,预后良好。结论　妊娠期喉结核对母婴健康有较大影响,临床医师应提高认识,对疑似喉结核患者,进行喉镜检查和病理活检。     

妊娠期喉结核临床分析CSCD

目的分析妊娠期喉结核的临床特点,减少误诊及不当治疗。方法选取厦门市妇幼保健院2010~2018年收治的4例妊娠期喉结核患者进行回顾性分析,总结分析其临床资料、病情特点及诊疗情况。结果 2例初诊为喉肿物,2例为急性咽喉部炎症,予抗生素治疗无效,行喉镜检查诊断为喉肿物。2例孕早期患者适时结束妊娠,4例患者均接受常规抗结核治疗,预后良好。结论妊娠期喉结核对母婴健康有较大影响,临床医师应提高认识,对疑似喉结核患者,进行喉镜检查和病理活检。     

鼻咽部结核临床分析并文献复习

目的总结鼻咽部结核的临床特点，为其诊断和治疗提供临床经验。方法回顾性分析2017年10月—2018年2月收治并经组织病理学和TB PCR证实的2例鼻咽部结核患者的临床资料。结果2例患者均经3个月规范抗结核治疗后痊愈，随访1年未复发。结论鼻咽部结核临床比较少见的发病部位，容易被误诊为鼻咽癌。组织病理学检查和TB PCR可以明确诊断，诊断明确后应进行规范的抗结核治疗。     

初诊鼻咽癌患者临床证型及体质类型调查

目的 调查初诊鼻咽癌患者临床证型及体质类型的分布情况。方法 采用舌、脉集体议定和分组调查方式，对47例初诊鼻咽癌患者的临床证型及体质类型分布情况进行调查，分析探讨初诊鼻咽癌患者临床证型与其体质类型的相关性。结果鼻咽癌初诊患者的临床证型以气血凝结型和火毒困结型为多见，体质类型则主要表现为气虚质、失调瘀质和失调热质。结论 鼻咽癌初诊患者的临床辨证多为实证，体质类型则主要呈现为虚弱质。 临证之际，在对患者临床证候进行治疗的同时，也应就其病理性体质予以调理，方能充分体现中医药在鼻咽癌综合治疗中的优势效用。     

鼻咽癌放疗后大出血的诊治

目的探讨鼻咽癌放疗后大出血的诊治方法及治疗结果。方法收集2011年1月~2015年12月诊治的7例鼻咽癌放疗后大出血患者,分析其临床特点、各种诊治方法的特点及疗效。结果7例鼻咽癌放疗后大出血患者,治愈出院2例,转院行颈内动脉栓塞1例,已治愈。住院期间死亡3例,1例自动出院后死亡。结论鼻咽癌放疗后大出血积极的检查明确出血原因及部位,针对出血原因及部位可采取治疗措施,包括预防性气管切开,不得已情况下的长时间填塞及颈内动脉栓塞,能够有效降低鼻咽癌放疗后鼻出血的死亡率。     

鼻咽癌误诊误治分析

鼻咽癌是耳鼻咽喉科常见恶性肿瘤,严重威胁人类健康和生存。早发现早治疗是提高鼻咽癌患者生存率的关键。因鼻咽癌临床症状复杂,位置隐蔽,易被误诊误治。现将笔者近年收集的有一定代表性的误诊病例报道如下,以供吸取教训。1典型病例1．1鼻咽癌误诊为“鼻中隔糜烂”、“慢性鼻咽炎”例1,金××,男,32岁,患者1年前发现鼻涕带血,去当地县中医院五官科就治。被诊断为“鼻中隔糜烂”,对症处理未愈,仍梯中带血。后来我科就治,经检查双侧鼻腔无出血灶,鼻中隔粘膜亦无糜烂迹象。遂行纤维鼻咽锐检查,在鼻咽部发现左侧异常隆起,局部毛…     

鼻咽结核1例并文献复习

目的分析鼻咽结核的临床特点及诊治要点。方法回顾性分析经病理确诊的鼻咽结核1例,并结合相关文献复习。结果患者以颈部无痛性包块为首发症状,经鼻咽部活检、组织病理学检查确诊。通过检索中国知网、万方以及Pubmed数据库中有关鼻咽结核的文献,共检索有关文献32篇,包含患者共194例。结论鼻咽结核临床表现缺乏特异性,易漏诊误诊,临床医生要提高认识,在诊治颈部包块时,应考虑鼻咽结核的可能,尽早反复送病理检查,从而明确诊断。     

Classification of nasopharyngeal microvessels detected by narrow band imaging endoscopy and its role in the diagnosis of nasopharyngeal carcinoma

Conclusions: The new NBI classification of nasopharyngeal mucosal microvessels was helpful in differential diagnosis for benign and malignant lesions of the nasopharyngeal region. NBI endoscopy facilitates the detection of superficial nasopharyngeal lesions and might enable early diagnoses of NPC.

Objectives: To propose a new microvessel diagnostic classification using narrow band imaging (NBI) endoscopy and to investigate the role of an NBI classification in the diagnosis of nasopharyngeal carcinoma (NPC).

Methods: Between January 2009 and December 2010, a total of 290 patients with a suspected nasopharyngeal tumor were enrolled in this study. The NBI endoscopic system was used to examine the nasopharynx. Each lesion was observed by NBI endoscopy and judged according to the detailed morphologic findings of epithelial microvessels. The superficial microvessel patterns were classified into five types (types I–V). The diagnostic effectiveness of NBI for benign and malignant nasopharyngeal lesions was evaluated.

Results: Approximately 93.5% (29/31) of lymphoid hyperplasia appeared as the type II microvessel pattern under NBI endoscopy, whereas 96.2% (51/53) of nasopharyngeal radiation-induced inflammation exhibited the type III or IV microvessel pattern. The characteristics of NPC under NBI endoscopy mainly appeared as a type V microvessel pattern (79.5%, 167/210), and the sensitivity, specificity, predictive value (PPV), and negative predictive value (NPV) of type V in the diagnosis of NPC were 79.5%, 91.3%, 96.0%, and 62.9%, respectively. NBI endoscopy could significantly improve the detection of superficial lesions (χ^2?=^?12.789, p?=?.000).     

鼻咽癌临床特征及82例误诊分析

目的 分析82例鼻咽癌的临床表现和误诊原因。方法 收集2002年11月至2009年11月我科收治、经病理确诊的82例鼻咽癌患者的病史资料,分析其临床表现及误诊率。结果 本组鼻咽癌病例的主要临床表现包括涕血、鼻塞、耳鸣、听力下降、头痛、颈部包块、颅神经损害和Horner′s征。EBV-VCA-IgA阳性率为93.90%。首诊时的误诊率为67.07%。结论 鼻咽癌的临床表现复杂,误诊率高,出现以上症状者宜进行仔细的耳鼻喉科检查。     

隐匿性结核感染导致喉软骨萎缩1例

目的 分析喉结核的临床特点及诊治要点。方法 回顾性分析上海交通大学医学院附属第九人民医院收治的1例隐匿性喉结核患者的临床资料,整理诊治经过,并结合相关文献复习。结果 患者以反复咽痛、声嘶起病,迁延10年,逐渐导致以会厌萎缩为特征的喉软骨病变。经完善检查排除肿瘤及自身免疫性相关疾病,符合结核感染特征,经抗结核治疗喉部黏膜病变逐渐消失。结论 喉结核临床表现缺乏特异性,首诊极易误诊为慢性喉炎或一般细菌感染。当临床上遇到以反复咽痛、声嘶为表现的年轻患者,喉镜检查见广泛的黏膜水肿、溃疡及息肉样增生,特别是伴有喉软骨萎缩的患者,需警惕隐匿性结核感染的可能。     

Factors associated with early diagnosis in pediatric vs adult nasopharyngeal carcinoma

Objective: To improve understanding of the initial symptom between pediatric and adult nasopharyngeal carcinoma (NPC) and to improve the early diagnosis of NPC.

Methods: This retrospective cohort study included all 353 patients with a primary diagnosis of NPC in the First Affiliated Hospital of Zhengzhou University from January 2010 to December 2016. Of these, 34 patients were 21 years or younger (pediatric); 319 patients, older than 21 years (adult). Data were analyzed after data collection.

Results: We found no difference between pediatric and adult patients in terms of their sex distribution (p?>?.05).Type III, undifferentiated carcinoma is the most common subtype in Pediatric patients, while adult patients had more squamous cell tumors (p?p?< .05). Of the 353 patients, 120 (34.0%) had only one presenting symptom initially; however, most patients presented two or more episodes. Neck mass was the most common presenting symptom initially in children and adolescents, while multiple ear symptoms in adult patients (p?=?.003). The median time from onset of the presenting symptom to diagnosis is three months, adult patient presented longer history (64.7% vs 44.55, p?p?p?>?.05). Among pediatric patients, 31 (91.2%) had positive EBV DNA in peripheral plasma. EBV DNA was significantly associated with stage (p?Conclusions: Although uncommon, pediatric NPC appears to affect a different patient demographic relative to adult NPC. NPC in children is associated with undifferentiated carcinoma and more advanced disease presentation.     

Correlation of PET-CT,MRI and histopathology findings in the follow-up of patients with nasopharyngeal cancer

IntroductionSurgical treatment options are limited for nasopharyngeal cancer for many reasons including epidemiological and histological properties, proximity to important structures, heavy lymphatic drainage, and the difficulty in ensuring a safe surgical margin; therefore primary treatment is generally radiotherapy and chemotherapy. With current radiotherapy technology, oncological success has been increased and the quality of life of patients during the post- radiotherapy period is improved.ObjectiveThe role of magnetic resonance imaging and positron emission-computed tomography in the follow-up of recurrent nasopharyngeal cancer patients who were initially treated with radiotherapy was evaluated with respect to histopathological findings.MethodsA total of 110 patients with nasopharyngeal cancer who had received radiotherapy were included in the study. Patients who were suspected to have recurrence according to endoscopic nasopharyngeal examination and magnetic resonance imaging findings were requested to undergo positron emission-computed tomography. Biopsies were taken from 40 patients who had suspicious lesions in positron emission-computed tomography images. These patients’ age, gender, presence/absence of contrast enhancement on magnetic resonance imaging, the SuvMax values of nasopharyngeal and neck lesions, T/N phases at initial diagnosis, histopathological recurrence, and history of neck dissection were assessed.ResultsRecurrence was observed in 8 patients (20.0%). Among these, 4 (10.0%) had recurrence at the nasopharynx and 4 (10.0%) at the neck. Patients with recurrence were found to be of older age, male gender, advanced T/N phase, contrast enhancement on magnetic resonance imaging, and higher nasopharyngeal and neck SuvMax values in positron emission-computed tomography. However, these differences were not statistically significant. Only the history of neck dissection was significantly more common among those with recurrence (p < 0.001). However, in multivariate analysis, those with a nasopharyngeal SuvMax value higher than 4.58 were found to have 7.667-fold higher risk for recurrence (p = 0.036).ConclusionsMagnetic resonance imaging and positron emission-computed tomography should be evaluated together in the follow-up of nasopharyngeal cancer. Patients with minimal SuvMax 4.58 on positron emission-computed tomography after contrast enhancement in the T2 sequence on magnetic resonance imaging may considered appropriate for biopsy. Biopsies in patients with a SuvMax value lower than 4.58 can be avoided. Thus, patients avoid surgical stress and unnecessary costs.     

以溃疡为主要表现的咽喉部病变临床诊治分析

目的 回顾分析10例以咽喉溃疡病变为主要表现患者的病历资料,为临床医师诊疗该类疾病提供参考。方法 对纳入的病例从临床表现、病变部位、溃疡特点、诊疗经过、病理诊断、预后情况进行分析,结合典型病例及文献复习阐述该类疾病的临床特点。结果 最后确诊喉结核6例(声门上区1例,声门区4例,声门下区1例),溃疡性咽喉炎2例、淋巴瘤1例、下咽癌1例。所有患者根据最后诊断接受相应治疗。结论 对咽喉部溃疡性病变,首先需明确诊断,除单纯溃疡外,应考虑到特异性感染、恶性肿瘤等疾病可能,明确诊断后才能精准施治,得到确切疗效。     

Characteristics of lingual thyroglossal duct cysts under flexible laryngoscopy and treatment approaches

ObjectivesLingual thyroglossal duct cysts (LTGDCs) are clinically rare and easily misdiagnosed as epiglottic cysts. Misdiagnosis leads to mistreatment; thus,simple diagnosis is important. This study aimed to investigate the characteristics of LTGDCs with flexible laryngoscopy and imaging, improve their diagnosis and explore surgical methods for patients undergoing an initial operation and patients with recurrence.MethodsIn total, 10 patients with LTGDCs were admitted from April 2014 to December 2020.By reviewing the diagnosis and treatment of the first typical case, the characteristics of LTGDC under flexible laryngoscopy were summarized. According to these characteristic manifestations, a clinical diagnosis of LTGDC was made correctly in the other 9 patients. All 10 patients underwent preoperative CT of the neck and sagittal reconstruction and thyroid ultrasound.ResultsOf the 10 patients, the first 2 patients had recurrent LTGDCs after several operations and underwent Sistrunk surgery. The remaining 8 patients were newly diagnosed and underwent endoscopic radical resection with low-temperature coblation; of these patients, 7 had no recurrence, and 1 underwent Sistrunk surgery after developing short-term recurrence. All patients were followed up for 5 months to 6 years after the last operation and were without recurrence.ConclusionLTGDCs are easily misdiagnosed as epiglottic cysts in the clinic. A correct clinical diagnosis can be made based on the characteristics according to flexible laryngoscopy. To determine the relationship between the cyst and hyoid bone, CT was performed. The surgical method was chosen based on the relationship between the cyst and hyoid bone and history of recurrence.     

The role of nasopharyngeal examination and biopsy in the diagnosis of malignant diseases

IntroductionIn direct proportion to the increasing rate of nasopharynx examinations applied, the early diagnosis and treatment of lesions in this region is possible. At times the clinical findings and the biopsy results are not consistent, so biopsies may have to be repeated.ObjectivesThe aim of this study was to evaluate the distribution of pathology test results obtained from cases of nasopharynx biopsy, to determine with which methods determination most often was made, and to investigate which kinds of cases required the biopsy to be repeated.MethodsThe study included a total of 1074 patients (500 female, 574 male) who underwent nasopharyngeal biopsy in our clinic between June 2011 and June 2017. Data were obtained from patient records of age, gender, clinical findings, imaging findings if available and pathological diagnosis. The pathological diagnoses were separated into 3 main groups as chronic nasopharyngitis, benign cytology and malignant cytology.ResultsThe examinations resulted in 996 cases reported as chronic nasopharyngitis, 47 as benign cytology and 31 as malignant cytology. Of the 31 malignant lesions, diagnosis was made in 15 patients (48.4%) with a single biopsy, and in 16 patients (51.6%), as a result of the pathology report when 2 or more biopsies were taken. In the comparison of the benign and malignant lesions in respect of the need for repeated biopsies, the cases determined with malignancy were found to have a statistically significantly higher rate of repeated biopsy (p < 0.001).ConclusionIn comparison with cases of benign tumor, a statistically significantly greater number of repeated biopsies were required in cases diagnosed as malignant tumors to confirm the pathological diagnosis or when there was continued suspicion of malignancy. Therefore, when there is clinical suspicion, even if there are no findings of malignancy on the first biopsy, the biopsy should be repeated expeditiously.     

鼻咽癌患者鼻咽组织和血清中EBV检测

目的：比较血清爱泼斯坦－巴尔病毒（ＥＢＶ）抗体滴定度测定与癌组织ＥＢＶ基因组检测对鼻咽癌（ＮＰＣ）的诊断价值。方法：１４６例患者采用双盲法测定血清ＥＢＶ－ＶＣＡ－ＩｇＡ,ＥＢＶ－ＥＡ－ＩｇＡ和活检组织ＥＢＶ－ＤＮＡ（ＰＣＲ）。全组病例按活检病理检查结果分析：ＮＰＣ组,非ＮＰＣ组（对照组）。结果：ＮＰＣ组中ＥＢＶ－ＤＮＡ（ＰＣＲ）,ＥＢＶ－ＶＣＡ－ＩｇＡ和ＥＢＶ－ＥＡ－ＩｇＡ的阳性率分别为９０．８％