Association between lymphangiogenesis and clinicopathological features and prognosis in laryngeal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To detect lymphangiogenesis by labeling the lymphatic endothelial marker, lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1), and study the prognostic relevance of lymphangiogenesis in laryngeal squamous carcinoma.</p><p><b>METHODS</b>Clinical files and specimens of 78 patients with histologically diagnosed laryngeal carcinoma were stained with LYVE-1 as a specific lymphatic endothelial marker. The lymphatic vessel density (LVD) was measured, and the correlation between LVD and clinicopathological features of the tumor cases was analyzed.</p><p><b>RESULTS</b>The mean LVD in laryngeal carcinoma (13.24 ± 5.09) was significantly higher than that in adult laryngeal papilloma (5.54 ± 3.15) and squamous dysplasia (6.76 ± 4.45, P < 0.05). The LVD of poorly differentiated tumors (15.74 ± 5.24) was significantly higher than that in the moderately differentiated tumors (13.84 ± 6.20), and the LVD in the moderately differentiated tumors was significantly higher than that in the well-differentiated tumors (11.68 ± 6.34). The LVD in stage 0 to stage II group (10.66 ± 5.70) was significantly lower than that in the stage III to IV group (17.01 ± 6.35). The lymph node metastasis group (17.25 ± 7.37) was significantly higher than non-lymph node metastasis group (8.60 ± 5.23, P < 0.05). There was no significant association between LVD and age, sex, primary site and distant metastasis. The overall survival in the patients with a LVD higher than the mean value was 33.5 month, and that of cases with a LVD lower than the mean value was 81.6 month (P < 0.05). The multivariate survival analysis showed that the clinical stage and LVD were independent prognostic factors of laryngeal cancer.</p><p><b>CONCLUSIONS</b>The LYVE-1 staining histochemistry demonstrates that the lymphangiogenesis occurrs mainly at the edge of the tumors, and lymphangiogenesis plays an important role in the carcinogenesis, cancer progression and lymph node metastasis in laryngeal cancer. LVD may be an independent indicator of poor prognosis of laryngeal cancer.</p>

Vocal fold augmentation by injection of autologous fascia and fat / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of combination of autologous fascia and fat injection into vocal fold for the treatment of patients with unilateral vocal fold paralysis and to observe the long-term effectiveness of this procedure.</p><p><b>METHODS</b>A total of 26 unilateral vocal fold paralysis patients underwent vocal fold injection under general anesthesia, meanwhile, the mucosa of the injected point was sutured through laryngoscope under direct vision. There were 6 patients underwent autologous fat injection into vocal fold (group A), and 20 patients underwent autologous anterior rectus sheath fascia and fat injection (group B). Therapeutic efficacy were evaluated by videostroboscopy, voice-related parameters analysis and voice evaluation before and after treatment. Clinical analysis of this procedure was retrospectively performed in this serial of patients.</p><p><b>RESULTS</b>All patients were followed up for 24 months. On the third day after operation, there was an acute inflammatory reaction induced by the graft. This reaction disappeared three months later. In all 20 cases, videolaryngostroboscopy showed significant improvement of the glottic closure, the improvement in acoustical parameters was statistically significant (P < 0.01). Perceptual evaluation of GRBAS scale showed significant improvement of phonatory function on G, B, A scale. The results remained stable 6 - 24 months after operation and were not changed by the length of follow-up. And in the 6 cases, videolaryngostroboscopy showed significant improvement of the glottic closure at 3 months compared with preoperative observation, a little spindle-shaped disclosure. The improvement in acoustical parameters was significant statistically at 3, 6 and 24 months (P < 0.05 or < 0.01), the voice quality decreased significantly at 6 and 24 months compared with 3 months (P < 0.05 or < 0.01). The significant differences were not observed between 6 and 24 months (P > 0.05). No complications were observed in all patients perioperatively or during the follow-up period. Voice-related parameters jitter, normalized noise energy and maximum phonation time showed significant differences between Group A and Group B on 24 months (P < 0.05 or < 0.01).</p><p><b>CONCLUSION</b>The combination of autologous fascia and fat vocal fold injection is an effective procedure for the treatment of unilateral vocal fold paralysis, and the stable results can be achieved during the follow-up period for 24 months.</p>

Tubed pectoralis major myocutaneous flap for reconstruction of circumference pharyngoesophageal defects / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and efficacy of tubed pectoralis major myocutaneous flap in the reconstruction of circumferential defects following resection for locally advanced hypopharyngeal and cervical esophageal carcinoma.</p><p><b>METHODS</b>From Dec. 2004 to Oct. 2008, 30 patients underwent immediate reconstruction by tubed pectoralis major myocutaneous flap for circumferential defects following resection of primary tumours. Among them, 22 were hypopharyngeal carcinoma, 7 were cervical esophageal carcinoma and one was recurrent laryngeal carcinoma involved the hypopharyngeal lumen. Five of 30 patients had received previous radiotherapy and three had failed in the previous surgical procedure. In this series, 12 patients had total pharyngolaryngectomy and 18 had total pharyngolaryngectomy and partial cervical esophagectomy.</p><p><b>RESULTS</b>Postoperative pharyngocutaneous fistula formation occurred in 4 patients, 2 of them with previous radiotherapy and 2 with diabetes, and the fistulae healed later. Two patients developed anastomotic strictures at the upper junction, but they had good responses to dilatation treatment and had satisfactory oral intake. The postoperative follow-up time ranged from 8 to 56 months. Median follow-up was 18 months. One-year survival rate was 71.4% and three-year survival rate was 42.5%.</p><p><b>CONCLUSIONS</b>The tubed pectoralis major myocutaneous flap is a reliable procedure to reconstruct hypopharyngeal circumferential defects following resection of advanced hypopharyngeal and cervical esophageal carcinoma. This method may be the optimal choice for the reconstruction of hypopharyngeal circumferential defects following resection of recurrent carcinoma. The incidence of fistula and stenosis could be kept at an acceptable level.</p>

Recurrent laryngeal nerve decompression / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the result of recurrent laryngeal nerve decompression in the treatment of functional disturbance of recurrent laryngeal nerve caused by thyroid surgery or thyroid benign tumors.</p><p><b>METHODS</b>From October 2002 to June 2005, 9 cases of unilateral recurrent laryngeal nerve paralysis and 4 cases of glottic insufficiency were treated with recurrent laryngeal nerve decompression. Seven cases of the nerve paralysis were caused by the surgery of benign thyroid tumors resection which were done by general surgeons. The paralysis nerve were found ligated in 6 of the 7 cases, and nerve-scar adhesion was found in the other case. Beside nerve decompression, type I thyroplasty have been undertaken in the same time to 2 of the 7 cases with severe hoarseness. One case of thyroid adenoma and 1 case of nodular goiter with unilateral recurrent laryngeal nerve paralysis were treated with tumor resection and nerve decompression respectively. Four cases of glottic insufficiency, 3 cases of nodular goiter were treated with tumor resection and nerve decompression, and Hashimoto's thyroiditis in the other case was treated with partial lobe resection and nerve decompression. The recovery of function of recurrent laryngeal nerve were detected to the recovery of vocal cord mobility through electrolaryngoscope postoperatively.</p><p><b>RESULTS</b>For the 7 cases of recurrent laryngeal nerve paralysis after thyroid surgery, the motion of the paralysed vocal cord restored within 3 months in 6 cases with the interval of 1 week to 3 months between the two operations, no restoration was found in the other patient with an interval above 4 months between the two operations after 1 year follow-up. For the thyroid adenoma and nodular goiter with unilateral recurrent laryngeal nerve paralysis, the motion of paralysed vocal cord restored within 3 months respectively after decompression. The glottic closure recovered within 1 week after decompression in the 4 cases of the glottic insufficiency patient.</p><p><b>CONCLUSIONS</b>Exploration and decompression as soon as possible to the paralysed recurrent laryngeal nerve because of thyroid surgery are very important for the restoration of the function of the nerve. For the patient with serve hoarseness, nerve decompression and type I thyroplasty at the same time is recommended in an effort to relieve hoarseness as soon as possible. For the functional disturbance of recurrent laryngeal nerve with thyroid neoplasm patient, early exploration and decompression of the nerve is imperative.</p>