Risk factors of level Ⅵ lymph node metastasis in cN0 papillary thyroid carcinoma / 临床耳鼻咽喉头颈外科杂志

Objective:To study the risk factors related to level Ⅵ lymph node metastasis in clinical N0 (cN0) papillary thyroid carcinoma (PTC). Method:A total of 107 cases with cN0 PTC treated in the same group were analyzed retrospectively. The frequency and risk factors for level Ⅵ lymph node metastasis in these patients were analyzed. Result:Level Ⅵ lymph node metastasis existed in 51.40% (55/107) cases. In univariate analysis, level Ⅵ lymph node metastasis was associated with age (χ²＝9.090,P<0.01), gender (χ²＝5.061,P<0.05), tumor maximum diameter (χ²＝8.772,P<0.01), tumor multifocality (χ²＝8.120,P<0.01), capsular invasion (χ²＝4.960,P<0.05), and surrounding tissue invasion (χ²＝3.858,P<0.05), but not with nodular goiter or Hashimoto's thyroiditis. Multivariate logistic analysis indicated that age,tumor maximum diameter, multifocal tumors and surrounding tissue invasion were independent risk factors for level Ⅵ lymph node metastasis. Conclusion:A high risk level Ⅵ lymph node metastasis exists in DTC with clinical N0. Prophylactic level Ⅵ neck dissection is strongly recommended in patients with PTC who are younger, tumor size more than 2 cm, multifocal tumor and surrounding tissue invasion.

CO2 laser assisted posterior cordotomy for bilateral vocal cord paralysis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the feasibility and efficacy of CO2 laser assisted posterior cordotomy for patients with bilateral paralysis of the vocal cord.@*METHOD@#Twenty-one patients with bilateral paralysis of the vocal cord underwent CO2 laser assisted posterior cordotomy in our hospital from Jul. 2009 to Jun. 2015. The causes of the bilateral paralysis of the vocal cord were thyroidectomy in 15 cases, cervical trauma in 2 cases, resection of pituitary tumor in 1 case, inflammation in 1 case and without cause in 2 cases. Ten patients underwent tracheotomy before the operation; 9 patients underwent tracheotomy after the operation; 2 cases without tracheotomy.@*RESULT@#The tracheotomy tube was plugged next day after posterior cordotomy. Lots of patients were breathing well without any effort. A few patients were breathing hard, so the tracheotomy tube was plugged discontinuously. Seventeen patients were decannulated 1 year after operation. Two patients were failed to decannulated. The patients were followed up for 3 months 6 years after operation, and all of them were breathing well.@*CONCLUSION@#Our limited experience showed that CO2 laser assisted posterior cordotomyis an effective and reliable surgical procedure for patients with bilateral paralysis of the vocal cord.

Analysis of negative cordectomy specimens using CO2 laser for T1 glottic cancer / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#This study determined presence or absence of residual cancer in the surgical specimen and analyzed outcomes.@*METHOD@#A retrospective study of 57 patients with glottic carcinoma (7 Tis, 47 T1a, and 3 T1b) treated from January 2000 to February 2010. All histological slides from the 57 patients were re-examined under the light microscope by the pathologist and the surgeon. We performed multiple biopsies and intraoperative biopsy as a diagnostic procedure.@*RESULT@#There were 5, 4, 41, 3, and 4 types I to V cordectomies, respectively. 6 negative cordectomies (10.5%) were reported.@*CONCLUSION@#The endoscopic treatment of T1 glottic cancer should be as conservative as possible. This assures resection of all the malignant tissue and preserves the maximum amount of healthy tissue.

The depth of CO2 laser cordectomy in T1 glottic carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate if routine resection of thyroarytenoid muscle (TA) with T1 glottic carcinoma treated by endoscopic CO2 laser cordectomy is necessary.@*METHOD@#A cohort of 57 patients staged as T1 underwent endoscopic CO2 laser cordectomy at a single institution was retrospectively analyzed. Seven had Tis, 47 T1a and 3 T1b; 9 cases were treated with type I or II cordectomies, and 48 patients underwent type III, IV or V cordectomies, with resection of all or part of the TA. All histological slides from the 48 patients were re-examined under the light microscope for TA invasion by the pathologist and the surgeon. Survival and local control were calculated using the Kaplan-Meier method.@*RESULT@#The follow-up period for the 57 patients ranged from 4 to 119 months (mean follow-up 41.5 months). Among the 4 patients who died, 1 of them was related to the glottis carcinoma and 3 others had died of other causes with no evidence of locoregional glottic disease. The 5 year overall survival, 5 year disease-specific survival and 5 year disease-free survival were 89.1%, 96.3% and 78.1%, respectively. When the study ended, 10 (17.5%) local and 1 regional recurrences had been observed. Over a total of 57 patients, 5 (8.8%) cases showed TA invasion. Open salvage therapy was performed during follow-up. Six patients had partial laryngectomy. Four patients had total laryngectomy and one with neck dissection. One patient had radical neck dissection because of late regional relapse was proven by histopathologic examination. Thus, the larynx was preserved in 93.0% (53/57).@*CONCLUSION@#TA invasion found histologically in T1 glottic carcinoma. TA resection can be performed conservatively according to an accurate preoperative and intraoperative evaluation of macroscopic tumour extension.

Diagnosis and treatment of the parapharyngeal space tumors / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the diagnosis and treatment of the parapharyngeal space tumors.@*METHOD@#The clinical data of 22 patients with parapharyngeal space tumors treated in our hospital were retrospectively studied. All the patients underwent surgery. The tumors located in the left parapharyngeal space in 14 cases and in the right parapharyngeal space in 8 cases.@*RESULT@#Different surgical approaches were used: transcervical in 19 cases, transcervical-transmandibular in 2 cases, transoral in one case. The tumors were neurogenic origin in 15 cases, salivary gland origin in 4 cases, and others in 3 cases proved by postoperative pathology. Of these, 18 (81.8%) were benign and 4 (18.2%) malignant. Two patients with malignant tumors died 2 and 3 years respectively after operation due to recurrences, and others showed no evidence of recurrence after follow up for over one year. The fine-needle aspiration biopsy guided by ultrasonography provided the correct results of benign or malignant tumors in 4 cases.@*CONCLUSION@#The image examination of the neck can identify the tumors in the parapharyngeal space. The fine-needle aspiration biopsy guided by ultrasonography can differentiate the tumor between benign and malignancy. Surgery is the mainstay treatment for tumors in the parapharyngeal space.

Clinical and pathological characteristics of antrochoanal polyps / 中国耳鼻咽喉头颈外科

OBJECTIVE To study the clinical and pathological characteristics of antrochoanal polyps. METHODS From Oct. 1998 to Sept. 2004, 1023 cases(1895 sides)of chronic sinusitis and/or nasal polyps were treated with endoscopic sinus surgery. Forty-six patients were diagnosed with antrochoanal polyps; all had a unilateral lesion. The average age of these patients was 15a. The polyps from these patients were fixed in formalin and embedded in paraffin. The sections were cut,stained with HE and observed under light microscope. RESULTS All 46 patients were cured after following up for more than 1 year. The antrochoanal polyps were usually unilateral and appeared in younger patients. The main symptom was nasal obstruction. Macroscopically,they had a cystic intramaxillary portion and a solid intranasal portion. Microscopically,the polyps were covered by pseudostratified ciliated columnar epithelium. The inflammatory cell infiltration in submucous tissue was mainly that of neutrophil cells with few eosinophil cells. Edema and cyst were also found in the submucous tissue. CONCLUSION The pathological findings and clinical features of the antrochoanal polyps indicate that antrochoanal polyps has a different pathogenesis compared with the usual nasal polyps. It should be named antrochoanal cysts rather than antrochoanal polyps.