Factors associated with incomplete surgical margins in basal cell carcinoma of the head and neck

IntroductionCutaneous basal cell carcinoma recurrence is associated with inadequate surgical margins. The frequency of and the factors associated with compromised or inadequate surgical margins in head and neck basal cell carcinoma varies.ObjectiveThe purpose of this study was to evaluate the clinical and pathological factors associated with inadequate surgical margins in head and neck basal cell carcinoma.MethodsWe developed a cross-sectional study comprising all patients who had undergone resection of head and neck basal cell carcinoma from January 2017 to December 2019. Data on age, sex, head and neck topography, histopathological findings, and staging were retrieved and compared. Each tumor was considered an individual case. Compromised and close margins were termed “inadequate” or “incomplete”. Variables that were significantly associated with the presence of incomplete margins were further assessed by logistic regression.ResultsIn total, 605 tumors from 389 patients were included. Overall, sixteen cases (2.6%) were classified as compromised, 52 (8.5%) as close, and 537 (88.7%) as free margins. Presence of scleroderma (p = 0.005), higher Clark level (p < 0.001), aggressive variants (p < 0.001), invasion beyond the adipose tissue (p < 0.001), higher T stage (p < 0.001), perineural invasion (p = 0.002), primary site (p = 0.04), multifocality (p = 0.01), and tumor diameter (p = 0.02) showed association with inadequate margins. After Logist regression, multifocality, Clark level and depth of invasion were found to be independent risk factors for inadequate margins.ConclusionGross clinical examination may be sufficient for determining low prevalence of inadequate surgical margins when treating head and neck basal cell carcinoma in highly experienced oncologic centers. Multifocality, Clark level and depth of invasion were found to be independent risk factors for incomplete margins.     

高级别宫颈鳞状上皮内病变LEEP术后病理升降级的相关因素分析

目的 探讨宫颈高级别鳞状上皮内病变(HSIL)宫颈环形电切术(LEEP)患者术后病理升降级的相关因素.方法 回顾性分析2019年1月至2020年6月在上海交通大学附属国际和平妇幼保健院就诊的经阴道镜活检组织学诊断为HSIL并接受LEEP手术的449例患者的临床资料,比较各相关因素与术后病理升降级的关系.结果 ①年龄＜4...     

外阴癌腹股沟前哨淋巴结切除术的研究进展

外阴癌的主要转移方式是淋巴结转移,存在淋巴结转移的患者5年生存率仅有25％～41％,严重影响患者的预后.传统的方式是外阴局部根治性切除术+腹股沟淋巴结清扫术,但是腹股沟淋巴结清扫由于手术范围大、创伤大,同时也带来了较高术后并发症如淋巴水肿、淋巴囊肿和切口延迟愈合等,尤其长期的下肢淋巴水肿,是最严重的长期并发症,影响患者...     

子宫颈锥切术后高危型人乳头瘤病毒阳性者规范化管理的专家共识

        随着我国子宫颈癌筛查与早诊早治工作的不断推进,子宫颈癌前病变的治疗是子宫颈癌二级预防的关键节点。2014年世界卫生组织（WHO）采用新的命名标准化方案,将子宫颈上皮内瘤变（CIN1、CIN2、CIN3）更名为低级别鳞状上皮内病变（low-grade squamous intraepithelial lesion,LSIL）和高级别鳞状上皮内病变（high-grade squamous intraepithelial lesion,HSIL）［1］,其中HSIL包括CIN2/3、中/重度游离鳞状上皮不典型性增生以及原位癌。大约20%的HSIL有可能在10年内进展为子宫颈浸润癌,故针对HSIL的早期诊断和规范治疗,在某种程度上能够有效预防子宫颈癌的发生。 浏览更多请关注本刊微信公众号及当期杂志。     

干扰素联合宫颈环形电切术治疗宫颈上皮内瘤变临床研究

目的 探讨干扰素联合宫颈环形电切术(LEEP)在治疗宫颈上皮内瘤变(CIN)中的作用.方法 对2003年1月至2005年1月大连市妇幼保健院收治,经细胞学、阴道镜定位活检、宫颈管搔刮术病理检查明确诊断为CINⅡ～Ⅲ级的60例病人,进行前瞻性随机对照研究.并对60例病人行LEEP前应用第2代杂交捕获试验(HC2)检测高危型人乳头瘤病毒(HPV)DNA,其中30例病人术前、术后加用干扰素治疗3个疗程为研究组,同时将单纯行LEEP的30例病人作为对照组.分别于治疗后3、6、9、12个月行液基细胞学检查(TCT)及阴道镜下可疑病灶活检,6、12个月行HC2检测以判断两组的疗效.结果 60例病人随诊中均无CIN残留及复发.治疗前两组各有2例HPV阴性.研究组术后6个月复查TCT 3例异常,HC2检测HPV 27例阴性,阴性率90%;术后12个月治愈率100%.对照组术后6个月复查TCT 16例异常,HC2检测HPV 13例阴性,阴性率43.3%;术后12个月复查TCT 4例异常,HC2检测HPV 19例阴性,治愈率63.3%.术后6个月及12个月研究组与对照组治愈率比较,研究组优于对照组(P＜0.05).结论 干扰素联合LEEP治疗CIN有双重阻断作用,提高了CIN病人一次性治愈率.     

Risk assessment to guide the prevention of cervical cancer

Advances in screening and diagnosis make it increasingly possible to prevent cervical cancer. However, if misused or poorly understood, these new tools will only increase costs and potentially harm patients without benefit. As a framework for standardized care that maximizes patient safety and well-being, we propose that a risk model be adopted to guide clinical management now and in the future. The model would use thresholds of increasing risk for cervical precancer and treatable cancer to guide clinical decision making for screening intensity, diagnostic evaluation, or treatment. Experts would decide on these risk thresholds and stratum based on the patient risk to benefit, independent of current (eg, cytology, carcinogenic HPV testing, and colposcopy) and future methods of measuring risk. A risk management model for cervical cancer prevention, based on appropriate clinical actions that correspond to risk stratum, can result in better allocation of resources to and increased safety for women at the greatest risk and increased well-being for women at the lowest risk.     

完整结肠系膜切除术与传统根治术治疗结肠癌的对比研究

目的：探讨完整结肠系膜切除术与传统根治术治疗结肠癌的临床疗效。方法选取2010年5月～2012年5月我院进行治疗的结肠癌患者137例,随机的分为研究组68例和对照组69例。观察术中的出血量、术后肛门排气时间,拔管时间,住院天数时间,术后开始进食时间;两组术后吻合口漏及残端肿瘤残余情况;及两组患者术中淋巴结切除情况。结果研究组术中的出血量、术后肛门排气、拔管、开始进食及住院时间皆优于对照组,两组比较,差异具有统计学意义（P＜0.05）。研究组患者吻合口漏1例,残端肿瘤残余2例,对照组分别为6例和8例,两组比较差异具有统计学意义（P＜0.05）。研究组患者的平均淋巴结数和阳性转移淋巴结数均多于对照组,两组比较差异具有统计学意义（P＜0.05）。结论完整结肠系膜切除术对结肠癌的治疗效果比较好,对人体的损伤小,并发症少,值得在临床上推广应用。     

Novel microstructured sildenafil dosage forms as wound healing promoters

Purpose: Study the possible benefit of combining biodegradable polymers with sildenafil citrate (SC) in wound healing.

Method: Biodegradable micronized powdered formulations of SC were prepared by spray drying using chitosan (P₁) or chitosan/gum Arabic (P₂). Powders were characterized by differential scanning calorimetry, Scanning electron microscope, particle size analysis, flow and swelling behavior. The powders were also incorporated into microstructured gels and in vitro SC release from powders and gels was tested. In vivo wound healing acceleration was tested by measuring area contraction of excision wounds and histologically. Post-healing tensile strength (TS) for incision wounds in rats receiving powder formulations was tested.

Results: The powders were in the micron-size range showing no SC–polymers interaction. Powders had poor flow with angle of repose (θ) of 41 – 48°, and high moisture uptake reaching 107% for placebo powder P_o1. Good excision wound healing was seen with P₁ and G₁ formulations showing 98.4 and 98.5% reduction in wound area, respectively, compared with 83% for the control. Incision wounds were improved with P₁ showing TS value of 6.9 compared with 3.7 kg/cm² for control. Histological examinations supported.

Conclusion: Spray-dried chitosan/SC powder (P₁) and its gel form (G₁) could be promising wound healing promoters as supported by the histological examinations.     

高危型人乳头瘤病毒检测联合液基薄层细胞学试验评估重度宫颈上皮内瘤样病变的宫颈电圈环切术治疗效果及预后

目的应用高危型人乳头瘤病毒（human papilloma virus,HPV）检测联合液基薄层细胞学试验（thinprep cytologic test,TCT）评价宫颈电圈环切术（loop electrosurgical excision procedure,LEEP）治疗重度宫颈上皮内瘤样病变（cervical intraepitheliai neoplasia,CIN）Ⅱ及Ⅲ的效果及预后。方法选择2005年11月至2006年12月在本院行宫颈电圈环切术的重度宫颈上皮内瘤样病变患者病变组织标本为研究对象。根据诊断结果分为CIN Ⅱ组（n=68,59．13％）,CIN Ⅲ组[包括原位癌（carcinoma in situ,CIS）]（n=47,40．87％）（本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准）。本组115例患者均于宫颈电圈环切术后4～6个月行液基薄层细胞学检测,6～8个月行高危型人乳头瘤病毒第二代杂交捕获法（hybrid captureⅡ,HC2）检查,并随访至2008年1月。采用回顾性分析法对其进行宫颈电圈环切术后疗效及预后分析研究。结果CINⅡ组行宫颈电圈环切术前,人乳头瘤病毒阳性率为73．53％（50／68）,CIN Ⅲ组为95．74％（45／47）,CIN Ⅲ组较CINⅡ组显著升高,两组比较,差异有显著意义（P〈0．05）。宫颈电圈环切术后,6例患者（5．22％,6／115）病灶残留或复发。宫颈电圈环切术前,人乳头瘤病毒呈阳性患者中,宫颈电圈环切术后,5例病灶残留或复发,占术前人乳头瘤病毒呈阳性总例数的5．26％,与术前人乳头瘤病毒呈阴性患者预后比较,差异无显著意义（P〉0．05）。术后随访中,第二代杂交捕获法人乳头瘤病毒检测灵敏度为66．67％,特异度为98．12％,阳性预测值为57．14％,阴性预测值为98．15％;液基薄层细胞学试验的人乳头瘤病毒检测灵敏度为83．33％,特异度为76．15％,阳性预测值为16．13％,阴性预测值为98．81％。宫颈电圈环切术后,人乳头瘤病毒及液基薄层细胞学试验检测均呈阳性的4例患者,全部病灶残留或复发,因此联合两种检测方法具更高的阳性预测值和特异度。结论宫颈电圈环切术是目前治疗重度宫颈上皮内瘤样病变的有效方法。高危型人乳头瘤病毒感染与重度宫颈上皮内瘤样病变的发生高度相关。术前对重度宫颈上皮内瘤样病变患者进行人乳头瘤病毒检测,对评估术后预后临床意义不大。人乳头瘤病毒检测联合液基薄层细胞学试验对评价宫颈电圈环切术效果及患者转归,具有重要临床价值。     

复发性翼状胬肉切除联合自体角膜缘上皮移植的疗效分析

目的:探讨翼状胬肉切除联合自体角膜缘上皮移植治疗复发性翼状胬肉的疗效。方法:对129例(135眼)复发性翼状胬肉在显微镜下行胬肉切除联合自体角膜缘上皮移植术。结果:术后观察10mo,复发2眼,复发率1%。结论:显微镜下行胬肉切除联合自体角膜缘上皮移植术治疗复发性翼状胬肉复发率低,疗效确切。