中耳耵聍腺肿瘤3例并文献复习

目的 探讨中耳耵聍腺肿瘤的临床病理特点、诊治方法及预后情况.方法 回顾分析确诊为不同类型耵聍腺肿瘤3例患者的临床资料,加以总结.结果 随访至2014年12月,其中1例中耳耵聍腺瘤患者术后6年,未见复发及转移;1例中耳耵聍腺癌患者经手术及放疗后(20 Gy)1年复发,再次手术及放疗,2年后出现面瘫怀疑肿瘤复发,因患者放弃治疗,未能明确,但随访6年仍存活;1例腺样囊腺癌患者行2次手术及P53治疗1年后发生颌下转移,再次手术及放疗,随访9个月后,影像学提示肿瘤复发并转移至颅内,未再治疗,至随访结束时仍存活.结论 中耳耵聍腺肿瘤的早期诊断困难,易复发,其确诊有赖于临床特点、影像学和组织病理学检查,其治疗方式及预后与肿瘤类型相关,耵聍腺瘤以手术治疗为主,耵聍腺癌及腺样囊性癌应采用以手术治疗为主的综合治疗.     

外耳道耵聍腺囊性腺样癌

外耳道盯聍腺囊性腺样癌是头颈部肿瘤中较为突起见的恶性肿瘤，本文就1976-1993年间收治的13例外耳道盯聍腺囊性腺样癌临床表现及治疗结果进行回顾，13例中男4例，女9例，年龄24-79岁，平均46.7岁，除1例拒绝治疗外，12例均接受了手术治疗，5例随访10年以上，6例随访2-4年，1例胡访1年，1例失访，随访10年的5例病人中3例死于癌转移，1例死于肺感染，1例存活；6例随访2-4年者均存活，无癌复发。结合文献息就外耳道盯聍腺囊性腺样癌的发病率、临床表现、病理特征、诊断、治疗及预后进行讨论。     

咽旁间隙肿瘤(附89例临床分析)

目的总结诊治咽旁间隙肿瘤的经验.方法回顾分析咽旁间隙肿瘤89例.术前为32例患者行针吸活检术,50例行CT检查;全部患者均行手术治疗,经腮腺入路29例,经颈入路45例,经颈-下颌骨外旋入路15例,术后全部标本作病理检查.结果针吸活检32例中27例诊断正确,CT检查50例中46例可准确判断肿瘤的位置;组织学检查良性肿瘤72例(81%),以恶性肿瘤、混合瘤多见37(42%).良性肿瘤术后10例复发(14%),恶性肿瘤12例复发或转移(74%).结论术前针吸活检和CT检查对诊断咽旁肿瘤有意义,经腮腺和经颈部入路是最常用手术进路.     

鼻腔鼻窦腺样囊性癌18例临床分析

目的：探讨鼻腔鼻窦腺样囊性癌的临床特点。方法：18例鼻腔鼻窦腺样囊性癌患者,16例行手术＋术后放疗,2例行单纯放疗。结果：随访5年,早期（Ⅰ、Ⅱ期）患者8例均无死亡;晚期（Ⅲ、Ⅳ期）患者10例,死亡5例,失访1例。高分化组11例中,1例死亡;中低分化组7例中,死亡4例,失访1例。结论：鼻腔鼻窦腺样囊性癌临床症状不典型,应提高对该病的认识,防止误诊;预后有赖于病理分型和临床分期;高分期及高侵袭性腺样囊性癌预后差。     

喉气管腺样囊性癌10例临床分析

目的 探讨喉气管腺样囊性癌的临床特点、治疗方法及预后。方法 回顾性分析10例行喉气管腺样囊性癌的临床资料,根据UICC　2002年TNM分期标准,喉腺样囊性癌T1N0M0 1例,T2N0M0 1例,T3N0M0 3例;根据Bhattacharwa分期,气管腺样囊性癌T1N0M0 1例,T2N0M0 3例,T3N0M0 1例。10例患者临床上以喉痛、声嘶、咳嗽及进行性呼吸困难伴喘鸣等为主要表现形式,采取手术加术后辅助放疗的治疗模式。喉腺样囊性癌以喉全切除术和喉部分切除术为主,气管腺样囊性癌以气管袖状切除加端端吻合术为主。术后辅助放疗,采用调强放疗方式,总剂量 60～70Gy。结果 10例患者术后愈合好,无并发症,随访时间为2个月～7年不等,所有病例均未见局部复发及远处转移。结论 喉气管腺样囊性癌临床上以进行性呼吸困难伴喘鸣、咳嗽及声嘶为主,纤维喉镜检查有利于早期发现。该病颈淋巴转移率低,预后较好。根治性切除加术后辅助放疗是治疗喉气管腺样囊性癌的最佳方法。     

侧颅底肿瘤手术入路(附44例报告)

目的:探讨切除侧颅底肿瘤的最佳入路.方法:44例患者中,采用下颌外旋入路17例,耳后C形切口入路16例,上颌外旋入路7例,颞额入路4例.结果:25例良性肿瘤术后无复发;19例恶性肿瘤中,术后生存不足1年2例,1年以上4例,2年以上7例,3年以上6例.结论:下颌外旋入路适用于切除咽旁间隙、颞下窝、鼻咽部、口咽部、蝶骨、斜坡及上颈椎肿瘤;耳后C形切口入路适用于切除颞骨肿瘤.     

耳部少见恶性肿瘤16例报告

耳部恶性肿瘤发病率低,Ｃｏｎｌｅｙ（１９７４）统计约占耳病总数的０．０２％～０．０２５％。１９６５～１９９７年我院共收治各类耳部恶性肿瘤５５例,其中临床少见的有１６例,现报告如下。１临床资料本组１６例中,男９例,女７例;年龄３～５７（平均３７．６）岁...     

外耳道耵聍腺源性恶性肿瘤(附13例报告)

目的 探讨外耳道耵聍腺源性恶性肿瘤的临床特征和治疗效果。方法 对13例耵聍腺源性恶性肿瘤手术病例进行随访和回顾性分析。结果 随访5年以上11例，随访3年以上2例，其中失访4例，无瘤生存7例，复发死亡2例。结论 对耵聍腺源性的恶性肿瘤，应早期行局部扩大或根治手术。放疗可作为手术切除后的辅助治疗。对所有病例应进行长期随访。对腺样囊性癌病例，尤其应注意肺部随访。     

原发性喉结核18例临床特征分析

目的：加强对原发性喉结核这一少见疾病的认识，以减少对此病的误诊误治。方法：我们对1988－2000年12年间经病理确诊，并排除了肺结核及肠结核的18例原发性喉结核进行回顾性分析。结果：本文18例同以往喉结核相比，在发病年龄、病变部位及临床表现诸方面有极大差异。结论：由于抗结核药的应用及肺结核的控制。原发性喉结核的症状日益不典型：（1）年龄偏大，老年患者居多。（2）声嘶多为首发症状；（3）病变部位多集中于真假声带，故在临床上对该病应有足够的认识，以期早期确诊、早治疗，减少不必要的并发症的发生。     

Sialoblastoma: a rare submandibular gland neoplasm

A sialoblastoma is a rare congenital epithelial tumor that arises in a major salivary gland. To our knowledge, only 24 cases of sialoblastoma have been previously reported in the English-language literature. We report a new case, that of a 15-month-old boy who presented with a submandibular mass. Surgical excision of the mass was undertaken. Intraoperatively, the mass appeared to be adjacent to the submandibular gland, but it had not invaded it. The mass was excised, and the submandibular gland was left in place. Pathology identified the tumor as a sialoblastoma. However, pathology also revealed that residual tumor was present at the surgical margin. The patient was returned to the operating room for excision of the left submandibular gland and the level I lymph nodes. Following revision surgery, the surgical margins were negative. The patient remained disease-free at the 1-year follow-up. Despite the need for revision surgery, this case provides support for the idea that surgery alone is sufficient for curative treatment.     

内镜下经口入路颌下腺切除术的临床分析

目的探讨内镜辅助经口入路颌下腺切除的有效性、安全性和可行性。方法经鼻插管全麻后,沿颌下腺导管开口至磨牙后区的下颌舌颌沟做弧形切口,内镜辅助下分别沿下颌下腺导管,切断与颌下腺有关的神经、血管、导管,将颌下腺切除。结果5例患者均顺利切除颌下腺,1例出现暂时性舌体麻木,2周后恢复。无面神经下颌缘支及舌下神经损伤,无其他并发症。颈部无瘢痕,美容效果好。结论内镜辅助下经口入路颌下腺切除术安全、可行,值得临床推广应用。     

无功能性甲状旁腺囊肿临床分析

目的 总结无功能性甲状旁腺囊肿患者的临床病理学特点,探讨其诊断和治疗方法.方法 回顾性分析北京同仁医院耳鼻咽喉头颈外科2002 -2009年收治的6例甲状旁腺囊肿患者的临床资料,患者均为体检时无意中发现颈部肿物,血钙、血磷及血甲状旁腺素正常,其中5例患者影像学检查提示甲状腺下极后方有囊性肿物.结果 6例患者均行手术治疗,术后病理证实为甲状旁腺囊肿,免疫组化染色甲状旁腺素、嗜铬素A及突触素均阳性.随访2～9年无复发.结论 手术是治疗甲状旁腺囊肿的有效方法,最终确诊需要依赖病理学检查.     

Myoepithelioma of the parotid gland: a report of two cases

We describe the clinical and pathologic features of two benign myoepitheliomas of the parotid gland. Through 1985, only 42 other cases had been reported in the literature--39 benign and three malignant. Fewer than 100 cases had been reported through 1993. Since then, two other reports have been published. But are these tumors really rare, or are they simply not well recognized? It is our opinion that they are not as rare as is generally believed because the number of case reports is increasing as pathologists have become more aware of their existence.     

Ceruminous gland tumors: report of three cases

Three patients with ceruminomata were treated by radiation therapy, surgery or a combination of both of them. One patient was treated by surgery followed by radiation treatment and then, after recurrence of the tumor, by radical surgery, and another patient treated by surgery only, are free from disease six and five years respectively. One patient treated by incomplete radiation therapy only, has had recurrence of the tumor three months later, but after a full treatment by Cobalt teletherapy is free from recurrence four months later. Surgery is considered the treatment of choice; however, radiation therapy may be indicated when the tumor, either primary or recurrent, has extended beyond limits of surgical resection, or because of distant metastases, due to the patient's general condition precluded surgery, or finally, when surgery is refused.     

开放性颈外伤临床分析

目的探讨开放性颈外伤的特点和救治方法。方法回顾我科近3年收治的18例开放性颈外伤患者的临床资料,主要治疗包括清创缝合、气管切开、抗休克、止血、抗感染、喉成形等。结果 13例患者顺利治愈,1例遗留右颈外动脉假性动脉瘤,1例因喉返神经损伤遗留声嘶,1例因局部感染严重无法Ⅰ期修复,1例术后冠心病严重发作死亡,1例并发脑梗塞离院。结论严重的开放性颈外伤危及生命,需及时救治,保持呼吸道通畅、止血、抗休克、喉成形等非常重要,挽救生命并尽可能恢复器官功能和防止呼吸道狭窄等并发症。     

Nasolabial cyst: a retrospective analysis of 18 cases

Nasolabial cysts are rare but easily identifiable when they do occur. They are thought to arise from the remnants of the nasolacrimal ducts, but most of the available information on these cysts is limited to isolated case reports. The purpose of our study was to examine the clinical and pathologic features of nasolabial cysts in order to provide a basis for their correct diagnosis and treatment. Eighteen patients with nasolabial cysts were treated at Korea University's Guro Hospital between Jan. 1, 1988, and Dec. 31, 1999. We retrospectively analyzed the clinical appearance, pathologic findings, and treatment results in each case. All patients underwent surgery via the sublabial approach. The lining epithelia were identified as either pseudostratified, stratified squamous, or simple cuboidal. A cyst recurred in only one case, and there were no surgical complications on follow-up. The results of our study provide a basis for sound diagnosis and treatment.     

儿童感染性内眼炎病因与临床分析 (附21例报告)

目的探讨儿童感染性内眼炎的病因、治疗方法及预防。方法回顾分析儿童感染内眼炎的致病原因,就诊时间与手术效果的关系。结果一次性注射器导致儿童感染性内眼炎12例,占57.14%,其中眼球萎缩5例,新生血管青光眼1例,视网膜脱离4例。经玻璃体切割和玻璃体内注射抗生素18例,其中9例视力提高。结论一次性注射器是导致儿童感染性内眼炎的主要原因;及早确诊行玻璃体切除术可挽救视功能。     

腮腺恶性肿瘤120例临床分析

对1984～1993年住院手术和术后放疗的腮腺恶性肿瘤120例进行了回顾。男63例,女57例。初治71例,复治49例;单纯手术治疗64例,手术加术后放疗56例。结果,腮腺恶性肿瘤的5、10年生存为80．0％和58．2％。单纯手术分别为79．7％,47．4％;手术加术后放疗分别为80．4％和63．9％。两种治疗方法的10年生存对比有明显差异（X2＝5．77,P＜0．05）。有无淋巴结转移的5年生存率分别为59．1％,83．6％,有明显差异（X2＝4．78,P＜0．05）。腮腺恶性肿瘤的疗效评价应区分高度和低度恶性。首次术式选择合理,术后放疗是减少局部复发的重要因素,颈淋巴结转移和分化差的晚期癌是影响预后的关键。