谷胱甘肽S转移酶M1基因缺失与喉癌易患性的相关性研究

目的 :建立聚合酶链反应 (PCR)方法检测谷胱甘肽 S转移酶 (GST) M1基因 ,并探讨 GST M1基因缺失 (无效基因型 )与喉癌易患性的相关性。方法 :观察组选择确诊的喉癌 4 2例 ,正常对照组 10 8例 ;取被检者外周静脉血白细胞 ,抽提制备脱氧核糖核苷酸 (DNA) ;选择优化后的 PCR反应体系和循环参数扩增 GSTM1,扩增后的基因产物用 2 %琼脂糖凝胶电泳 ,紫外线灯下观察并记录结果。结果 :(1)成功建立聚合酶链反应结合琼脂糖凝胶电泳技术检测 GSTM1基因的方法。(2 )喉癌组 GST M1基因缺失率 (71.4 % )明显高于正常对照组 (48.1% )显示两组之间差异存在显著性 (χ2 =6 .6 1,P<0 .0 5 )。结论 :(1)聚合酶链反应是一种简单敏感 ,准确可靠的分析 GST M1基因多态性的方法。 (2 )该地区 GST M1基因缺失与喉癌的易患性相关联     

The haemodynamic response to the insertion of the laryngeal mask airway: a comparison with laryngoscopy and tracheal intubation

The haemodynamic response to the insertion of the laryngeal mask airway (LMA) was assessed and compared to that of laryngoscopy and tracheal intubation in a study of forty patients (ASA 1) randomly allocated into two groups and anaesthetised using a standard balanced anaesthetic technique. The results show that the changes in all cardiovascular parameters measured following LMA insertion were significantly less (P<0.05) when compared with those following laryngoscopy and tracheal intubation. We conclude that airway management with the LMA may be used to avoid the haemodynamic response to tracheal intubation where such a response is undersirable.     

全喉切除改良气管-咽吻合Ⅰ期发声重建术

目的：探讨全喉切除Ⅰ期发声重建术的改进术式。方法：采用低位气管切开，全喉切除，食管前壁黏膜重建声门，气管切口处造瘘．颈段气管上提并缩窄吻合于舌根的方法行全喉切除及Ⅰ期发声重建木35例。结果：33例(94．29％）术后获得了不同程度的发声功能．不能发声者仅2例(5．71％)。全部患者术后均可经口进食，未出现严重的影响生存质量的误咽。结论：与以往的发声重建术相比，本术式具有发声成功率高、发声质量良好、误咽率低等优点，且无须置人人工发声装置．值得推广。     

Laryngeal pleomorphic rhabdomyosarcoma

A case of an extremely unusual tumor of the larynx, pleomorphic rhabdomyosarcoma, is presented with a review of literature. This is the fifth case of this malignancy described in the larynx in the English language literature. A histopathological diagnosis was made with immunohistochemistry and electron microscopy. In contrast to other reported cases, the tumor in the present case had a very aggressive behavior. Despite radical surgery involving total laryngectomy and neck dissection followed by radiation therapy, the patient died of disease 8 months following treatment. Received: 14 March 1997 / Accepted: 23 January 1998     

Prognostic factors in laryngeal carcinoma: the role of apoptosis,p53, proliferation (Ki-67) and angiogenesis

Even though the roles of different known or suggested prognostic factors in laryngeal cancer have been studied in detail, clinical stage at time of diagnosis and anatomic subsite of the tumour remain the only practical predictors of clinical outcome and offer the only guidelines in the planning of treatment. In this study, the relative roles of known demographic and clinical prognostic factors, in addition to four histopathological factors, were evaluated in a sample of 100 laryngeal carcinoma patients with multivariate analysis using the Cox regression model. In addition to advanced stage (stage III-IV) (relative hazard of death (HR) 8.9, p=0.01) and supraglottic disease (HR 5.6, p=0.02), high apoptotic index (HR 11.1, p=0.05) was significantly associated with poor survival. Cell proliferation, p53 and angiogenesis did not significantly affect the prognosis. In the future, high degree of apoptosis could be used to identify patients with poor prognosis in laryngeal cancer.     

Loss of heterozygosity on chromosomes 3p,8p,9p and 17p in the progression of squamous cell carcinoma of the larynx

Previous molecular genetic studies of laryngeal squamous cell carcinoma (SCC)have shown certain chromosomal regions with recurring alterations. But studies of sequential molecular alterations and genetic progression model of laryngeal SCC have not been clearly defined. To identify the chromosomal alterations associated with the carcinogenesis of laryngeal SCC, we analyzed genomic DNA from microdissected squamous metaplasia, squamous dysplasia, invasive SCC, and metastatic carcinoma samples from 22 laryngeal SCC patients for loss of heterozygosity (LOH) at microsatellite loci. Ten microsatellite markers on chromosome 3p, 8p, 9p, and 17p were used. LOH at 9p21 was observed in the all stages including squamous metaplasia, squamous dysplasia, invasive SCC and metastatic carcinoma. LOH at 17p13.1, 3p25 and 3p14.2 was observed from the squamous dysplasia, invasive SCC and metastatic carcinoma. LOH at 8p21.3-p22 was observed mainly from the invasive SCC and metastatic carcinoma. The results suggest that 9p21 in the early event, 17p13.1, 3p25 and 3p14.2 in the intermediate event and 8p21.3- p22 in the late event may be involved in the laryngeal carcinogenesis.     

143例晚期喉癌患者的临床特征及生存分析

目的 总结143例晚期喉癌患者的临床特征,分析预后的影响因素。方法 回顾性分析2010年1月-2016年12月经中国人民解放军总医院治疗的143例晚期喉癌患者的临床资料。其中,男135例(94.4%),女8例(5.6%);年龄35~79岁,中位年龄58岁。依据患者治疗方案不同分为2组:手术联合术后放化疗组106例和非手术综合治疗组37例。收集患者基本临床情况、治疗、随访及生存情况;生存率及单因素生存分析采用Kaplan-Meier法和log-rank检验,多因素生存分析采用Cox比例风险回归模型。结果 143例晚期喉癌患者的5年总体生存率为67.9%。单因素分析显示,影响晚期喉癌患者预后的临床因素有年龄、临床分期、T分期及肿瘤分化程度等(P值均<0.05);Cox模型多因素分析显示,患者年龄、临床分期、肿瘤分化程度及治疗方式是影响预后的独立危险因素(P值均<0.05)。T₄期、临床Ⅳ期患者采用手术联合术后放化疗5年生存率分别为62.2%和59.5%,明显好于非手术综合治疗的18.2%和41.4%,差异均有统计学意义(P值均<0.05)。结论 晚期喉癌患者预后相对较差,影响患者预后的因素包括患者年龄、临床分期、肿瘤分化程度及治疗方式等。对于临床Ⅳ期、尤其是T₄期患者,采取手术联合术后放化疗可以获得相对较好的预后。     

长托宁用于喉罩全麻术前用药的临床观察

目的研究选择性M受体拮抗剂长托宁用于喉罩全麻术前用药的临床效果。方法选取ASAⅠ～Ⅱ级行择期腹腔镜下胆囊切除术患者90例，随机分为3组（每组30例）：对照组（A组），术前不应用任何抗胆能药；阿托品组（B组）和长托宁组（C组），麻醉诱导前30min肌肉注射阿托品或长托宁0．01mg／kg，麻醉诱导后置入标准型喉罩后接麻醉机行机械通气；分别记录气管插管后5min（T1）、气管插管后30min（T2）、气管拨管前（T3）气道内分泌物量以及心率变化。结果在T1、T2、T3三个时点，B组和C组患者的气道分泌物明显少于A组（P〈0．05）；B组在T1时间点的心率明显高于A组与C组（P〈0．05）。结论长托宁用于喉罩全麻术前用药临床效果较好。