Repair surgical defect of squamous cell carcinoma of tongue base with advanced patients / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To repair the postoperative tissue detect of the base of tongue cancer in advanced patients.@*METHOD@#There were 30 patients of medium-high differentiation squamous cell carcinoma(SCC) included in this study. According to the TNM staging of AJCC 2002, there were 4 cases of T2N1M0, 7 of T3N1M0, 10 of T3N2M0, 4 of T4N1M0 and 5 of T4N2M0. Surgical approach of the primary lesion: 12 with transhyoidpharyngotomy approach and 18 with mandibulotomy approach. All cases accepted radiotherapy 4-6 weeks after surgery.@*RESULT@#Twenty-five cases were reconstructed with pedicle pectoralis major myocutaneous flaps, and all them survived. Among them, 1 flap was partial split with surrounding tissue spontaneously, and another flap had partial tissue necrosis, however, both flaps grew well with dressing and other local treatment. Other 5 cases were reconstructed with free anterolateral myocutaneous flaps. Among them, 1 flap had partial tissue necrosis, but had a secondary healing after removing necrotic tissue via mouth approach. All 18 patients of larynx-preservation had tracheal tube pulled out. The 3-year survival rate was 68% and the local control rate was 87%.@*CONCLUSION@#Pedicle pectoralis major myocutaneous flaps and free anterolateral myocutaneous flaps were alternative donor area for repairing postoperative tissue defect of the base of tongue; The former was preferred, and the latter was concealed so as to be a kind of effective method, which need adept technique of microsurgery.

The correlation between stanniocalcin 2 expression and prognosis in laryngeal squamous cell cancer / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#In this study, we have detected the expression of STC2 protein in laryngeal cancer and The safe incisal margin by immunohistochemical staining, to evaluate its correlation with clinical features and the prognosis value in laryngeal squamous cell cancer.@*METHOD@#Eighty-one paraffin-embedd specimens of patients who underwent surgery for laryngeal cancer were collected. Clinical data, including date of birth, gender, tumor subsite, tumor stage, RT, and survival status have been recorded. The samples including laryngeal cancer tissues and the safe incisal margin were analyzed for the expression of STC2 protein by immunohistochemical staining. We analyzed the correlations with STC2 expression level and clinical data with software SPSS 18. 0.@*RESULT@#(1)fifty-six cases in 81 cases (69. 1 %) are positive. In 30 cases of the safe incisal margin tissues, STC2 is not expressed, which shows statistically significant differences between the two groups (P 0. 05). (3)The result showed that the 3-year survival rate is 74. 1%, according to the survival analysis by STC2, STC2 positive group has poorer outcome versus the negative group. (4)The clinical stage displayed the independent value in predicting the tumor prognosis of laryngeal cancer (P<0. 05), not the expression level of STC2.@*CONCLUSION@#Overexpression of STC2 in laryngeal cancer patients is correlated with poor outcome, which means STC2 positive group has poorer prognosis than the STC2 negative group.

Evaluation the curative effect of supracricoid partial laryngectomy for laryngeal cancer / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the oncological outcomes, functional outcomes in patients undergoing supracricoid partial laryngectomy (SCPL). Provide clinical experience for application of SCPL.@*METHOD@#A retrospective analysis of the 115 cases with laryngeal carcinoma accepted SCPL in our department from Jan 1996 to Dec 2004. Use the Kaplan-Meier method to analyze the patients'survival rate. Evaluate the value of reserve larynx function.@*RESULT@#The 5-years survival rates and the decannulation rate was 80.8%, 99.1% respectively; and the average decannulation time was 22.25 days. The mean time of removal of gastric tube was 9.57 days. The function of CHEP was superior to CHP. The vocal function of 115 cases were all achieved in general communication.@*CONCLUSION@#SCPL get better oncological and functional outcomes and allows the preservation of the basic function of the larynx. It's a safe, effective technique and deserved to generalization.

Resection of nasopharyngeal angiofibroma using by midfacial degloving approach and modified maxillectomy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the feasibility of treatment on angiofibroma patients with stage III, IV by midfacial degloving approach and modified maxillectomy.@*METHOD@#From Feb. 2001 to Aug. 2004, midfacial degloving approach and modified maxillectomy was used for treating 7 angiofibroma patients with stage III, IV. Using Fisch stage: Five cases were in stage III, 2 cases were stage IV; 2 cases with stage III accepted midfacial degloving approach and modified maxillectomy. Five cases accepted midfacial degloving approach and Le fort I approach (stage III, 3 cases; stage IV, 2 cases). One patient accepted the combined therapy of facial approach and cranium approach. 6 cases accept the embolization of the artery which feed the tumor (2 cases in stage IV, 4 cases in stage III).@*RESULT@#The blood loss was (600 +/- 324) ml in operation, the blood loss in operation of patients with selective preoperative embolization was (483 +/- 165) ml. The blood loss of one case with no selective preoperative embolization was 1300 ml. The operating time was 129 +/- 22 min. The pathology of 7 cases was nasopharyngeal angiofibroma. For 30 to 72 months follow-up, No tumor recurrence were observed, one case in stage III accepted the selective preoperative embolization got the tumor recurrence 1 year after the surgery. After the second surgery, no tumor recurrence were seen till now.@*CONCLUSION@#For the patients in stage III, IV, midfacial degloving approach and modified maxillectomy is not only good for radical excision, curtating the operating time and blood loss, but also good for the cosmetic outlook and functional recovery. The selective preoperative embolization has a good significance on reducing the operating blood loss and tumor recurrence rate.

Evaluation of effectiveness of advanced tonsillar carcinoma by different treatment / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the treatment of advanced tonsillar carcinoma by radiotherapy plus salvage surgery (R+S) or surgery coupling with postoperative radiotherapy (S+R).@*METHOD@#Clinical data of 48 patients with advanced tonsillar carcinoma who were treated in The 2nd Affiliated Hospital of Sun Yat-sen University from June 1996 to June 2004 was retrospectively analyzed. The patients were divided into R+S group (group A, 21 cases) and S+R group (group B, 27 cases). Treatment outcomes were compared between these two groups. The QOL (quality of life) scale of Washington University (UW-QOL) was used to investigate the patient's quality of life.@*RESULT@#The 5-year survival rates were 42.9% in group A and 45.8% in group B, there was no significant statistical difference between the two groups (P < 0.05). Both the two treatment modalities could reduce the QOL in some degree. The average QOL score of 46 patients was 661.00 +/- 98.52 , group A was 696.09 + 90.70, while group B was 631.52 +/- 96.74, there was a significant statistical difference between the two groups (P < 0.05).@*CONCLUSION@#The two treatment modalities reached similar survivals. However, compared with the S+R, some patients who accepted treatment of R+S could avoid composite resection, reduce functional lesion and improve the QOL.