喉咽癌手术放疗后甲状腺功能减退

本文对４２例喉咽癌手术及放疗后患者甲状腺功能的变化的初步探讨表明：在治疗结束后不同时间内有５７．１％的患者Ｔ４降低及（或）ＴＳＨ升高，其中放疗结合甲状腺部分切除者其发生率高达７３．９％，而未行甲状腺部分切除者仅３８．５％，两者呈显著差异（Ｐ＝０．０３）。术前或术后放疗对甲状腺功能影响较小，亦无明显差异。发生时间在治疗结束后２年内尤其在１年左右为多见。     

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.     

Endoscopic stapled diverticulotomy: a real advance in the treatment of hypopharyngeal diverticulum

Between November 1993 and May 1996, 51 patients with a hypopharyngeal diverticulum were treated by endoscopic stapled diverticulotomy. Normal swallowing was resumed within 36 h of surgery in 73%, and in 93% by 72 h. Two patients required nasogastric feeding for 5–7 days. There were no operative deaths or serious operative morbidity, and there have been no recorded cases of clinical recurrence of pouches to date (maximum follow-up 562 days: 46 cases over 12 months). The low morbidity, short hospital stay and early return to normal feeding, combined with a relative absence of complications or pouch recurrence, make endoscopic stapled diverticulotomy the treatment of choice for the majority of patients.     

Value of ultrasonography in laryngeal and laryngopharyngeal cancers

High-resolution sonography has improved in the past few years and has become a very valuable tool in the diagnosis of diseases of the head and neck. Ultrasonography (US) is commonly the first imaging modality after clinical examination. It is inexpensive, noninvasive and is easily tolerated by patients. It provides valuable diagnostic information with a high degree of diagnostic accuracy. This article provides the most up-to-date information about the indications, findings and limitations of high-resolution sonography in the evaluation of laryngeal and laryngopharyngeal cancers.     

下咽癌78例术后放疗临床疗效及预后分析

目的 探讨下咽癌手术＋术后放疗的临床疗效及影响下咽癌生存率和局控率的因素.方法 回顾性分析1979年2月～2001年4月收治的手术＋术后放疗下咽癌78例,Kaplan-Meier法分析3、5年生存率和局控率,Logrank进行单因素分析,Cox模型进行多因素分析.结果 60例手术＋术后下咽癌放疗下咽癌病人3、5年生存率分别为58.1%和41.9%,3、5年局控率分别为82.3%和75.6%.多因素分析显示T分期,N分期以及临床分期是影响下咽癌生存率的独立预后因素;T分期和临床分期是影响下咽癌局控率的独立预后因素.结论 T分期,N分期和临床分期是影响下咽癌长期生存的独立预后因子,T分期和临床分期是影响下咽癌局控率的独立预后因子.     

Transoral robotic surgery in patients with stage III/IV hypopharyngeal squamous cell carcinoma: treatment outcome and prognostic factor

Abstract

Background: We aimed to reduce the morbidity related to treatment and to preserve organ function in patients with hypopharyngeal squamous cell carcinoma (HPSCC) by applying a new surgical treatment protocol based on transoral robotic surgery (TORS).

Aims/objectives: In this study, we analyzed the prognostic factors related to survival to confirm the validity and effectiveness of TORS in patients with advanced-stage HPSCC.

Methods: We retrospectively analyzed the data of 44 HPSCC patients who had undergone TORS-based therapy.

Results: In univariate analysis, only the surgical marginal status showed a statistically significant correlation with the survival of the patients (p?=?.009). In multivariate analysis, surgical margin status was the only statistically significant prognostic factor related to survival (p?=?.008). Forty-one patients (93.2%) recovered speech function sufficiently to perform daily conversation without artificial aids. Forty-one patients (93.2%) were able to ingest food orally.

Conclusions: In the treatment of advanced hypopharyngeal cancer, TORS-based therapy helped the surgeon obtain a clear surgical margin in patients with HPSCC, and it showed superior oncologic and functional outcomes compared to the existing treatment methods.     

Gastroesophageal reflux disease and patterns of reflux in patients with idiopathic pulmonary fibrosis using hypopharyngeal multichannel intraluminal impedance

Idiopathic pulmonary fibrosis (IPF) is a diffuse fibrotic lung disease of unknown etiology. The association between IPF and gastroesophageal reflux disease (GERD) has been suggested. The objective of this study was to determine the prevalence of GERD and assess the proximity of reflux events in patients with histologically proven IPF using hypopharyngeal multichannel intraluminal impedance (HMII). This is a retrospective review of prospectively collected data from patients with histologically confirmed IPF (via lung biopsy) who underwent objective esophageal physiology testing including high‐resolution manometry and HMII. Defective lower esophageal sphincter (LES) was defined as either LES pressure of <5.0 mmHg, total length of LES of <2.4 cm, or intra‐abdominal length of LES of <0.9 cm. Abnormal esophageal motility was considered present when failed swallows ≥30% and/or mean wave amplitude <30 mmHg was present. HMII used a specialized impedance catheter to directly measure laryngopharyngeal reflux (LPR) and full column reflux (reflux 2 cm distal to the upper esophageal sphincter). Based on the previous study of healthy subjects, abnormal proximal exposure was considered present when LPR ≥1/day and/or full column reflux ≥5/day were present. From October 2009 to June 2011, 46 patients were identified as having pulmonary fibrosis and sufficient HMII data. Of 46, 10 patients were excluded because of concomitant connective tissue diseases, and 8 patients were excluded because they had undergone lung transplantation, which may impact the patterns of reflux. The remaining 28 patients with histologically confirmed IPF (male 16, female 12) were included in this study. Mean age and BMI were 60.4 years (range, 41–78) and 28.4 (range, 21.1–38.1), respectively. All patients except one were symptomatic; 23 (82%) patients had concomitant typical GERD symptoms such as heartburn, whereas 4 (14%) patients had isolated pulmonary symptoms such as cough. Esophageal mucosal injury such as esophagitis and Barrett's esophagus was found in 17 (71%) patients, whereas hiatal hernia was found in 19 (73%) patients. Abnormal proximal exposure, which occurred almost exclusively in the upright position, was present in 54% (15/28) of patients. There was no significant difference in clinical symptoms, objective findings of GERD, and pulmonary functions such as forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and diffusing capacity of the lung for carbon monoxide (DLCO) between patients with and without abnormal proximal exposure. Although the total number of reflux events was significantly higher in patients with abnormal proximal exposure, a large number of patients had a negative DeMeester score regardless of whether abnormal proximal exposure was present (patients with, 80%; those without, 85%). Patients with abnormal proximal exposure more likely had a defective LES compared with those without (93% vs. 75%). Fourteen patients (56%) had abnormal esophageal motility including aperistaltic esophagus (n = 9). This first study of HMII in patients with IPF demonstrated that GERD is highly prevalent (>70%), and abnormal proximal reflux events such as LPR and full column reflux are common despite a frequently negative DeMeester score. HMII may be beneficial in the work‐up of GERD in patients with IPF.     

肌醇多磷酸5-磷酸酶(PIPP)在人下咽癌组织的表达及临床意义

目的研究肌醇多磷酸5-磷酸酶(PIPP)在人下咽癌中的表达,探讨其临床意义。方法对15例人下咽癌组织学标本和15例正常的癌旁组织进行免疫荧光和免疫印迹检测。结果 PIPP的表达量及荧光强度在下咽癌组织中明显低于正常组织。结论 PIPP在下咽癌组织中低表达可能为临床提供新的诊断指标。