颈廓清术在咽喉部癌放疗后颈部残留或复发灶应用的初步探讨

本文报告对4例晚期鼻咽癌及3例晚期喉癌,在根治量放疗已控制原发灶而颈部包块仍不消退或复发的情况下,施行挽救性颈廓清术8侧,有效地改善了病人生存质量;认为,只要各方面处理得当,不应轻易放弃放疗失败病例的手术机会。     

牙线牵引辅助内镜黏膜下剥离术治疗胃角黏膜病变的疗效（含视频）

目的 探讨牙线牵引辅助内镜黏膜下剥离术（endoscopic submucosal dissection, ESD）治疗胃角黏膜病变的疗效。方法 回顾性分析2015年1月—2018年12月厦门大学附属第一医院内镜中心收治的127例胃角黏膜病变患者病例资料。根据术中手术方法,将患者分为牙线牵引辅助ESD组（牵引组,n=51）和传统ESD组（传统组,n=76）,同时把41例胃角纤维化病例也分为牵引组(n=23)和传统组(n=18)。对比分析手术时间、整块切除率、治愈性切除率及出血、肌层损伤、穿孔等不良事件发生率等指标。结果 牵引组与传统组病例年龄、性别、病变大小及病变形态差异无统计学意义（P＞0.05）。牵引组手术时间较传统组明显缩短[（65.4±36.5） min比(103.5±43.2) min,P=0.012],病变整块切除率[100.00%(51/51)比90.79%(69/76),P=0.026]及治愈性切除率均更高[94.12%(48/51)比81.58%(62/76),P=0.042],且剥离过程中肌层损伤[5.88%(3/51)比25.00%（19/76）,P=0.010]及术中出血更少[47.06%（24/51）比82.89%（63/76）,P=0.010]。传统组2例(2.63%)纤维化病例穿孔,牵引组无穿孔病例,穿孔发生率差异无统计学意义（P=0.243）。在胃角纤维化病例中,牵引组手术时间较传统组明显缩短[（81.4±29.3） min比(119.3±37.6） min,P=0.010],病变整块切除率[100.00%（23/23）比72.22%(13/18）,P=0.007]及治愈性切除率均更高[95.65%(22/23)比72.22%(13/18),P=0.035],且剥离过程中肌层损伤[8.70%(2/23)比72.22%(13/18）,P=0.001]及术中出血更少[78.26%(18/23)比100.00%(18/18),P=0.035]。结论 牙线牵引辅助ESD治疗胃角黏膜病变及有纤维化的胃角病变安全有效,与传统ESD相比,手术时间更短,治愈率更高,不良事件发生率更低。     

甲状腺癌咽旁/咽后淋巴结转移的临床诊治与预后分析

目的探讨甲状腺癌咽旁/咽后淋巴结转移的临床特点、治疗方法与预后。方法回顾性分析2007年1月至2016年12月因咽旁/咽后淋巴结转移行手术治疗的28例甲状腺癌患者的临床资料,总结其临床病理与手术治疗特点及预后情况。其中男10例,女18例;年龄20～78岁,中位年龄55岁。5例为初治患者,23例为再次治疗患者（其中15例有侧颈部淋巴结清扫史）。采用Kaplan-Meier法分析患者生存状况,采用log-rank检验对患者5年生存率进行单因素分析。结果16例转移淋巴结位于鼻咽部或口咽部水平（舌骨平面以上）,12例转移淋巴结位于喉咽部水平（舌骨平面以下）。所有患者均经颈部切口入路达根治性切除。全组患者术后出现局部或颈部淋巴结复发5例,出现咽旁淋巴结复发2例,伴远处转移8例。随访中死亡5例,其中1例死于肺转移,3例死于颈部肿瘤进展,1例死于恶病质,5年累积生存率82.5%。单因素分析显示,咽旁/咽后淋巴结转移的部位对生存率的影响有统计学意义（P＜0.05）。结论甲状腺癌咽旁/咽后淋巴结转移虽然病期较晚,但通过积极治疗,预后仍较好。颈部切口入路手术切除是其主要治疗手段。喉咽部水平（舌骨平面以下）转移者预后相对较差。     

急性主动脉夹层患者首发症状与院前延迟的关系研究

目的 探讨急性主动脉夹层患者首发症状与院前延迟的关系,为临床实施院前针对性健康教育提供参考.方法 选取急性主动脉夹层患者488例,收集患者首发症状、一般资料、疾病相关因素、院前相关因素及院前时间,分析首发症状与院前延迟的关系.结果 患者院前时间为135.5(48.3,1735.5) min,其中院前时间≤150 min...     

颈清患者保留及重建肩功能的研究进展

<正>1906年,Crile等人针对头颈部恶性肿瘤易发生颈淋巴结转移的情况提出了根治性颈淋巴清扫术(radical neck dissection,RND),这一术式在后来的很多年里,挽救了许多患者的生命。但RND损伤了副神经和颈部的一些重要的解剖结构,常导致患者斜方肌瘫痪萎缩,出现翼状肩胛、垂肩、肩周疼痛麻木、手臂活动受限、功能障碍等并发症,     

胃癌淋巴结转移的临床病理研究

为探讨胃癌淋巴结转移与原发癌临床病理学特性的关系，给选择合理的淋巴结清除范围提供依据，作者统计分析了手术切除的１９２例胃癌标本，结果：本组胃癌的淋巴结转移率为６０．４％，转移度为２８．９％。     

Role of lateral neck dissection in cancers of the larynx and hypopharynx with No neck

Radical neck dissection is a standard procedure carried out for the teatment of palpable nodes in the neck but if carried out electively in cases where there are no palpable nodes in the neck it is considered to be an overtreatment with its associated morbity. Lateral neck dissection was carried out on twenty patients who had T31 T4 lesion of the larynx and hypophar-vnx with NO neck. The dissection entails removal of Level II. III and IV nodes. Occult metastasis 80% and 85% respectively. The mean follow up was 13 monts. It appears from our study that elective lateral neck dissection is a promising and safe procedure and may be useful as an important prognostic tool in sampling the lymph nodes and predicting recurrences in the neck.     

Regional lymph node staging in prostate cancer: Prognostic and therapeutic implications

The role of pelvic lymph node dissection (PLND) in prostate cancer, in which patients and to what extent it should be performed, remains a controversial topic. Preoperative diagnostic methods are more or less unreliable for lymph node staging and PLND remains the most reliable and accurate method. PLND is indicated in all patients with a PSA value >10 ng/ml and in those with a PSA <10 ng/ml if the Gleason score is ≥7. If PLND is performed then it should always include the tissue along the external iliac vein, in the obturator fossa and on either side of the internal iliac vessels, up to where the ureter crosses the common iliac vessels. In conjunction with RRP extended PLND may increase staging accuracy, influence decision making with respect to adjuvant therapy and possibly impact outcome.     

Vertebral Artery Dissection: Natural History, Clinical Features and Therapeutic Considerations

When a tear occurs in one of the major cervicocerebral arteries and allows blood to enter the wall of the artery and split its layers, the result is either stenosis or aneurysmal dilatation of the vessel. Vertebral artery dissection (VAD) is an infrequent occurrence but is a leading cause of stroke in young and otherwise healthy patients. This article discusses recent developments in understanding of the epidemiology and pathogenesis of VAD and the various clinical manifestations, methods of diagnosis, and approaches to treatment.     

Spontaneous recovery from renal infarction resulting from renal artery dissection

A 31-year-old, previously normotensive healthy man developed right flank pain and was admitted to a medical service. Right renal infarction was suspected by enhanced abdominal computed tomography (CT) and arteriography. Fourteen days after the onset, he was transferred to the Oita University Hospital, Oita, Japan. Renal angiography revealed an isolated renal artery dissection causing renal atrophy due to main stem narrowing of the right renal artery. Renogram and renal scintigram with (99m)Tc-diethylene triamine pentaacetic acid revealed a remarkable decline in the glomerular filtration rate and almost no uptake in the right kidney. Four months later, in spite of our belief that functional recovery could not be expected, intravenous pyelography and enhanced abdominal CT scans revealed a functioning right kidney that had spontaneously recovered from the renal artery dissection through conservative management.