颈分区性清扫术治疗头颈部鳞状细胞癌的远期疗效

目的　研究颈分区性清扫术在头颈部鳞状细胞癌 (简称鳞癌 )治疗中的效果。方法　回顾性分析 1997年 1月～ 2 0 0 1年 12月在中国医学科学院肿瘤医院接受分区性清扫术的头颈部鳞癌患者 12 3例 ,其中喉癌 77例、口腔癌 2 9例、口咽癌 2例、下咽癌 15例。分区性清扫术后发现淋巴结病理阴性 (pN0 ) 99例 ,淋巴结病理阳性 (pN + ) 2 4例。随访时间中位数为 2 5个月。结果　 10 1例cN0患者行分区性清扫术后发现pN + 14例 ( 13 9% ) ;2 2例cN +患者行分区性清扫术后发现pN + 10例( 4 5 5 % )。 15 7侧分区性清扫标本中共发现 5 2枚阳性淋巴结 ,其在颈部的分布如下 :Ⅰ区 2 5 % ,Ⅱ区4 8% ,Ⅲ区 2 5 % ,Ⅳ区 2 %。根据Kaplan Meier方法计算 5年颈部复发率 ,pN0患者为 5 87% ( 95 %可信区间 0 8% ,10 9% ) ,pN +患者为 9 2 % ( 95 %可信区间 0 0 % ,2 1 5 % )。结论　颈分区性清扫术从微创观念出发 ,只要选择恰当 ,对于头颈部鳞癌患者可以取得与传统颈清扫术相当的效果。更重要的是保留了患者的功能和外观 ,提高了生活质量     

头颈部坏死性筋膜炎7例临床分析

目的：探讨头颈部坏死性筋膜炎的病因、临床表现、诊断和治疗，加强对这一罕见疾病的认识。方法：回顾分析1992-2002年10年收治的7例头颈部坏死性筋膜炎的病例资料并复习文献。结果：7例全部行积极的内科保守治疗和外科处理（包括局部切开引流、清创术和气管切开术），其中2例死亡。结论：临床上对该病应有足够的认识，以期早期诊断。及时有效的外科处理是治疗成功的关键。     

Simplification of laparoscopic extraperitoneal colposuspension: Results of two-port technique

Purpose: The aims of the present prospective study were to apply a new simplification for Laparoscopic Burch Colposuspension and to assess the postoperative results of this treatment modality for stress urinary incontinence.Materials and methods: Twenty-four patients underwent simplified laparoscopic procedure via two ports, utilising endoscopic tacker and two stripes of prolene mesh. Patients were evaluated for operative time,duration of urethral catheter, length of hospital stay, complications and continence status.Results: The technique was successful in 21 patients after 24 months follow-up. Average operative time was 39 minutes. The lengths of urethral catheterisation and hospital stay were 22 and 45 hours, respectively. One operative complication and three postoperative recurrences were recorded.Conclusion: Laparoscopic bladder neck suspension continues to develop as the instruments and techniques are improved. In carefully evaluated patients, it provides safe and minimally invasive procedure. We report the results of a new technique to simplify and speed up a laparoscopic extraperitoneal colposuspension. This revised version was published online in August 2006 with corrections to the Cover Date.     

脐带绕颈对围生儿的影响

目的　探讨脐带绕颈对围生儿的影响。方法　选择脐带绕颈 32 6例进行回顾性分析 :①分析脐带长度与脐带绕颈的关系 ;②比较脐带绕颈周数对围生儿影响 ;③比较脐带绕颈与不绕颈者对围生儿影响。结果　脐带过短组无一例发生脐带绕颈 ,脐带过长组的脐带绕颈发生率明显高于脐带正常组 (P <0 .0 1) ,脐带绕颈的胎儿窘迫率为 2 1.8% ,新生儿窒息率为8 0 % ,新生儿病死率为 0 .9%。结论　脐带绕颈与脐带长度有一定的关系 ,脐带过长是导致脐带绕颈的基本原因。脐带绕颈会明显增加胎儿窘迫、新生儿窒息及死亡的发生率     

头颈部神经鞘瘤275例临床分析

目的:对头颈部神经鞘瘤进行临床分析.方法:1969年7月～2002年9月共收治头颈部神经鞘瘤342例,占全身神经鞘瘤的58.6%(342/584),随访275例,随访率80.4%.结果:术前诊断为神经鞘瘤者仅为184例,误诊率为33.1%(91/275).本组7例复发(包括3例恶性),肿瘤发生最多的神经为交感神经、臂丛神经和迷走神经.结论:神经鞘瘤60.0%左右发生在头颈部.绝大部分为良性,恶性极少(3/275).主要治疗方法为手术,恶性神经鞘瘤对放、化疗不敏感,预后差.     

Serious adverse effects of amifostine during radiotherapy in head and neck cancer patients

Background and purpose: Amifostine has been shown to protect against xerostomia induced by radiotherapy for head and neck cancer, but its impact on the therapeutic index is unknown. This is the first report focusing on amifostine related adverse effects leading to discontinuation of amifostine treatment.

Patients and methods: Thirty-nine patients from two centers irradiated for head and neck cancer received i.v.-infusions of amifostine prior to each radiation fraction. In a phase III study, two daily amifostine doses, 200 mg/m² (n=21) and 340 mg/m² (n=18), were compared for protection against radiation induced toxicity. Total radiation dose was 60–70 Gy (2 Gy per fraction), nine patients received concurrent chemotherapy with cisplatin/5-FU. amifostine was usually discontinued after >1 episode of serious toxicity during subsequent treatment sessions.

Results: In 16/39 patients (41%) amifostine was discontinued due to severe adverse effects, which led to discontinuation of the phase III study. In four of 16 patients radiotherapy was delayed due to amifostine related adverse effects for 1–3 days. Discontinuation occurred more often in patients receiving chemotherapy. The results led to a literature review for amifostine treatment during radiotherapy in head and neck cancer patients. Regarding our series and published series using an amifostine schedule comparable to ours, total discontinuation rate was 27% (57/214). Discontinuation was significantly influenced by chemotherapy (P=0.007), but not by amifostine dose (P=0.156).

Conclusion: Daily i.v. administration of amifostine during radiotherapy in head and neck cancer is associated with a high rate of serious adverse effects leading to discontinuation of amifostine treatment and sometimes delay of radiotherapy.     

胸大肌肌皮瓣在头颈部肿瘤术后组织缺损修复中的应用

目的 总结胸大肌肌皮瓣在头颈部肿瘤术后组织缺损修复中的应用。方法 1992年10月至2001年12月，对80例头颈肿瘤患者应用81块胸大肌肌皮瓣进行一期组织修复。结果 全组肌皮瓣完全存活71块。2块肌皮瓣皮肤完全坏死。8块肌皮瓣皮肤远端轻度坏死。结论 胸大肌肌皮瓣血供可靠，修复操作简单，用途广泛，能满足头颈部肿瘤术后缺损的修复。     

134例头颈部肿瘤手术后缺损修复

目的：分析4种皮瓣修复头颈部缺损的效果、功能、并发症和供区创伤的大小，以为不同的缺损选择不同的皮瓣。方法：134例头颈部肿瘤患者，均行联合根治术加胸大肌肌皮瓣、颈阔肌肌皮瓣、额瓣、前臂皮瓣修复。结果：胸大肌皮瓣全部存活96例，部分坏死21例，坏死≥1／25例，全部坏死2例，颈阔肌皮瓣全部存活2例，部分坏死1例，全部坏死1例，4例额瓣和2例前臂皮瓣全部存活。结论：口腔及颈部大面积缺损需要胸大肌肌皮瓣修复，对需要洞穿修复的，尤其是女性，应尽量避免用胸大肌折叠瓣，可用复合瓣。对一般的口腔缺损用前臂皮瓣修复最为合适。     

头颈部肿瘤患者自然杀伤细胞活性及计数分析

本文对25例头颈部肿瘤患者的外周血NK细胞杀伤活性及NK细胞计数进行测定，其中有15例患者手术治疗切除肿瘤，于术后三周复查NK活性及NK计数，并与正常人组对照。实验结果显示：头颈部肿瘤患者NK活性及NK计数均低于正常人，两组比较均有极显著性差异（P＜0．01）；术后患者的NK活性比术前有明显提高，配对t检验P＜0．01，NK计数比术前也有所提高，配对t检验P＜0．05，有显著性差异；NK活性的水平与肿瘤的分期有相关性，晚期（T4期）癌症患者NK活性明显低于早期（T1、T2）患者，可以看出NK活性随着肿瘤的发展而降低，肿瘤对宿主有免疫抑制作用；NK活性与NK数量之间无显著的相关性，二者之间的相关系数r＝0．344。     

In vitro T-lymphocyte function in head and neck cancer patients

T-lymphocyte cell function was studied in vitro in peripheral blood mononuclear cells (PBMC) from 61 male patients with head and neck squamous cell carcinomas compared to 46 control patients. Patients older than 80 years or with reduced tumor-related performance status as measured by Karnofsky score less than 75 were excluded. In contrast to previous similar studies, control subjects ensured a minimum stress load by sampling all patients on the day of either diagnostic or therapeutic surgery. PBMC were separated by density-gradient centrifugation and subsequently cultured with autologous sera in vitro. The mitogen concanavalin A (Con A), which stimulates all T-cell clones, was employed. Findings showed that increased Con A stimulation and PBMC proliferation occurred with PBMC from cancer patients compared to that from control patients. In contrast, no differences could be detected with respect to the stimulated supernatant level of interleukin-2, interleukin-4 or interferon-γ between the groups. These results suggest that T-lymphocytes from PBMC are generally affected by neoplastic disease through either a supporting cell or serum factor.