Classificatory updates in verrucous and cuniculatum carcinomas:Insights from the 5^(th) edition of WHO-IARC head and neck tumor classification

The International Agency for Research on Cancer(IARC)and World Health Organization(WHO)collaboratively produce the'WHO Blue Books'essential tools standardizing the diagnostic process for human cancers.Regular updates in this classification accommodate emerging molecular discoveries,advances in immunohistochemical techniques,and evolving clinical insights.The 5th edition of the WHO/IARC classification of head and neck tumors refines the'Oral Cavity and Mobile Tongue'chapter,including sections for non-neoplastic lesions,epithelial tumors,and tumors of uncertain histogenesis.Notably,the epithelial tumors section is rearranged by tumor behavior,starting with benign squamous papillomas and progressing through potentially malignant oral disorders to oral squamous cell carcinoma(OSCC).The section on OSCC reflects recent information on epidemiology,pathogenesis,and histological prognostic factors.Noteworthy is the specific categorization of verrucous carcinoma(VC)and carcinoma cuniculatum(CC),both associated with the oral cavity and distinct in clinical and histologic characteristics.This classification adjustment emphasizes the oral cavity as their predominant site in the head and neck.Designating specific sections for VC and CC aims to provide comprehensive insights into these unique subtypes,elucidating their clinical features,distinct histological characteristics,prevalence,significance,and clinical relevance.By categorizing these subtypes into specific sections,the 5th edition of the WHO classification aims to provide a more nuanced and detailed account,enhancing our understanding of these specific variants within the broader spectrum of head and neck tumors.

Reconstruction surgery in head and neck cancer patients amidst the COVID-19 pandemic:Current practice and lessons for the future

The coronavirus disease 2019(COVID-19)pandemic has imposed a radical change in daily life and work routine.In this context,health systems have suffered important and serious repercussions in all fields.Among the changes brought about by the state of global health emergency,adjustments to guidelines,priorities,structures,professional teams,and epidemiological data stand out.In light of this,the oncological field has witnessed several changes in the approach to cancer,whether due to delay in diagnosis,screening deficit,personnel shortage or the psychological impact that the pandemic has had on cancer patients.This article focuses on the management of oral carcinoma and the surgical approaches that oral and maxillofacial specialists have had at their disposal during the health emergency.In this period,the oral and maxillofacial surgeons have faced many obstacles.The proximity of maxillofacial structures to the airways,the need of elective and punctual procedures in cancerous lesions,the aggressiveness of head and neck tumors,and the need for important healthcare costs to support such delicate surgeries are examples of some of the challenges imposed for this field.One of the possible surgical'solutions'to the difficulties in managing surgical cases of oral carcinoma during the pandemic is locoregional flaps,which in the pre-COVID-19 era were less used than free flaps.However,during the health emergency,its use has been widely reassessed.This setback may represent a precedent for opening up new reflections.In the course of a long-term pandemic,a reassessment of the validity of different medical and surgical therapeutic approaches should be considered.Finally,given that the pandemic has highlighted vulnerabilities and shortcomings in a number of ways,including the issues of essential resource shortages,underinvestment in public health services,lack of coordination and versatility among politicians,policymakers and health leaders,resulting in overloaded health systems,rapid case development,and high mortality,a more careful analysis of the changes needed in different health systems to satisfactorily face future emergencies is essential to be carried out.This should be directed especially towards improving the management of health systems,their coordination as well as reviewing related practices,even in the surgical field.

Factors influencing comfort level in head and neck neoplasm patients receiving radiotherapy

Objective:To determine factors that influence comfort in head and neck neoplasm patients receiving radiotherapy.Methods:In total,200 head and neck neoplasm patients receiving radiotherapy were recruited from three tertiary first class hospitals.They were assessed by Radiotherapy Comfort Questionnaire for patients with head and neck neoplasm,Social Support Scale,and Medical Coping Modes Questionnaire.Results:The total score of comfort was 60.54±8.32.Multiple linear regression analysis indicated that number of radiation treatments,family accompaniment,educational level,resignation coping mode,complications due to diabetes,accompanying chemotherapy,and the utilization of social support significantly influenced comfort level(p<0.05).Among these,number of radiation treatments,complications due to diabetes,accompanying chemotherapy,and resignation coping were negative factors.Conclusion:Encouraging utilization of social support systems and a positive coping mode is important for increasing comfort level in head and neck neoplasm patients during radiotherapy.Nurses should pay particular attention to those patients during later stages of radiotherapy or chemotherapy,with diabetes,without family accompaniment,and with lower education level.

Targeting head and neck tumoral stem cells： From biologicalaspects to therapeutic perspectives

Head and neck squamous cell cancer(HNSCC) is the sixth most common cancer in the world. Effective therapeutic modalities such as surgery, radiation, chemotherapy and combinations of each are used in the management of the disease. In most cases, treatment fails to obtain total cancer cure. In recent years, it appears that one of the key determinants of treatment failure may be the presence of cancer stem cells(CSCs) that escape currently available therapies. CSCs form a small portion of the total tumor burden but may play a disproportionately important role in determining outcomes. CSCs have stem features such as self-renewal, high migration capacity, drug resistance, high proliferation abilities. A large body of evidence points to the fact that CSCs are particularly resistant to radiotherapy and chemotherapy. In HNSCC, CSCs have been increasingly shown to have an integral role in tumor initiation, disease progression, metastasis and treatment resistance. In the light of such observations, the present review summarizes biological characteristics of CSCs in HNSCC, outlines targeted strategies for the successful eradication of CSCs in HNSCC including targeting the self-renewal controlling pathways, blocking epithelial mesenchymal transition, niche targeting, immunotherapy approaches and highlights the need to better understand CSCs biology for new treatments modalities.

Restricting carbohydrates to fight head and neck cancer——is this realistic?

Head and neck cancers(HNCs) are aggressive tumors that typically demonstrate a high glycolytic rate, which results in resistance to cytotoxic therapy and poor prognosis. Due to their location these tumors specifically impair food intake and quality of life, so that prevention of weight loss through nutrition support becomes an important treatment goal. Dietary restriction of carbohydrates(CHOs) and their replacement with fat, mostly in form of a ketogenic diet(KD), have been suggested to accommodate for both the altered tumor cell metabolism and cancer-associated weight loss. In this review, I present three specific rationales for CHO restriction and nutritional ketosis as supportive treatment options for the HNC patient. These are(1) targeting the origin and specific aspects of tumor glycolysis;(2) protecting normal tissue from but sensitizing tumor tissue to radiation- and chemotherapy induced cell kill;(3) supporting body and muscle mass maintenance. While most of these benefits of CHO restriction apply to cancer in general, specific aspects of implementation are discussed in relation to HNC patients. While CHO restriction seems feasible in HNC patients the available evidence indicates that its role may extend beyond fighting malnutrition to fighting HNC itself.

Rupture of carotid artery pseudoaneurysm in the modern era of definitive chemoradiation for head and neck cancer:Two case reports

BACKGROUND Carotid blowout syndrome(CBS)is a rupture of the carotid artery and is mainly caused by radiation and resection of head and neck cancers or direct tumor invasion of the carotid artery wall.It is a life-threatening clinical situation.There is no established and effective mode of management of CBS.Furthermore,there is no established preceding sign or symptom;therefore,preventive efforts are not clinically meaningful.CASE SUMMARY We described two cases of CBS that occurred in patients with head and neck cancer after definitive chemoradiotherapy(CRT)using three-dimensional conformal intensity-modulated radiation therapy.Two men aged 61 and 56 years with locally advanced head and neck cancer were treated with definitive CRT.After completing CRT,both of them achieved complete remission.Subsequently,they had persistent severe pain in the oropharyngeal mucosal region and the irradiated neck despite the use of opioid analgesics and rehabilitation for relief of contracted skin.However,continuous follow-up imaging studies showed no evidence of cancer recurrence.Eleven to twelve months after completing CRT,the patients visited the emergency room complaining about massive oronasal bleeding.Angiograms showed rupture of carotid artery pseudoaneurysms on the irradiated side.Despite attempting to secure hemostasis with carotid arterial stent insertion and coil embolization,both patients died because of repeated bleeding from the pseudoaneurysms.CONCLUSION In patients with persistent pain in irradiated sites,clinicians should be suspicious of progressing or impending CBS,even in the three-dimensional conformal intensity-modulated radiation therapy era.

Evaluation of Quality of Life and Oral Changes of Patients in Head and Neck Radiotherapy: Observational Study

Radiotherapy (RT) in the head and neck, despite coming from technological evolution, is challenged by the acute and late side effects of local irradiation, including permanent loss of saliva, osteoradionecrosis, dental caries induced by radiation and necrosis of the oral cavity, mucositis, xerostomia and secondary infections like candidiasis. Since these manifestations are limiting and the integrity of the vital organs contemplates the patient’s general health status, the oral health-related quality of life (OHRQoL) can be significantly affected by the treatment of head and neck cancer (HNC), since cancer can cause important changes in vital functions related to communication, food and social contact, causing disturbances in the patient’s life. An observational and longitudinal study was carried out with 16 cancer patients submitted to RT in the head and neck, between the years 2019-2020 with the objectives of collecting clinical and epidemiological data on the main oral changes caused by RT in the head and neck and correlating them with the impact on OHRQoL. To analyze the OHRQoL, the University of Washington’s Quality of Life Assessment questionnaire (UW-QOL) was applied once a week for 4 weeks and to observe oral manifestations, a dental clinic file standardized by the researchers was applied. The main oral manifestations clinically observed were hyposalivation, trismus and oral mucositis. The UW-QOL presented pain, chewing and taste as the main complaints reported by patients, however, appearance, salivation and chewing showed statistically significant differences over the weeks. The main manifestations observed were hyposalivation, trismus and oral mucositis, the physical limitations resulting from these manifestations impact the OHRQoL of cancer patients in terms of appearance, salivation and chewing.

38例头颈部髓外浆细胞瘤临床分析

目的探讨头颈部髓外浆细胞瘤(head and neck extramedullary plasmacytoma,HNEMP)的临床特征、危险因素、治疗及预后。方法回顾性分析2008年9月~2022年1月间北京同仁医院收治的38例新诊断且未治疗的HNEMP患者的临床资料,分析影响生存的因素及其预后。结果38例患者中,病变呈现鼻颅眶沟通性者5例(13.2%),肿瘤最大直径≥5 cm者8例(21.1%)。仅接受单纯手术切除的患者17例(44.7%),术后给予放疗者13例(34.2%),化疗者8例(21.1%),接受放化疗联合治疗者5例(13.2%)。治疗后评价疗效,完全缓解32例,部分缓解3例,疾病稳定1例,疾病进展2例。中位随访86个月,5年的无进展生存率和总生存率分别92.1%和94.7%。其中,颅鼻眶沟通病变患者中位无进展生存期仅13个月,5年的无进展生存率和总生存率为40%和60%,而其余组均为100%。此外,病变范围≥5 cm和累及鼻颅眶沟通是影响患者无进展生存率和总生存率的不良预后因素。结论HNEMP发病率低,治疗上以手术联合放疗为主,预后相对较好,颅鼻眶沟通病变及高肿瘤负荷为不良预后因素。

恶性肿瘤同步放化疗患者的营养状况及其影响因素

目的调查恶性肿瘤同步放化疗患者营养状况并分析其影响因素。方法以自设问卷方式收集2019年3-5月于北京大学肿瘤医院行同步放化疗恶性肿瘤患者的相关临床资料。采用患者参与主观整体评估量表(PG-SGA)评估患者的营养状况,并分析其影响因素。结果共收回有效问卷150份。150例患者的PG-SGA评分中位数为6.0(3.0,11.0)分。56例(37.3%)患者重度营养不良,49例(32.7%)患者中度营养不良。单因素分析显示,老年、食管癌或头颈部肿瘤、Ⅳ期、放疗次数>15次、化疗次数>4次、紫杉醇+铂或铂类单药治疗方案是患者营养不良的影响因素(Z=-3.839~-2.087,P<0.05)。二元logistic回归分析显示,老年、食管癌或头颈部肿瘤、放疗次数>15次是患者重度营养不良的独立危险因素(P<0.05)。结论恶性肿瘤同步放化疗患者营养不良比例高,尤其是老年、食管癌或头颈部肿瘤、同步放化疗后期患者。医务人员应动态评估、监测患者营养状况,并及时干预。

头颈癌患者身体意象研究的范围综述

目的 对国内外头颈癌患者身体意象相关研究进行范围综述。方法 检索PubMed、Web of Science、Embase、The Cochrane Library、CINAHL、中国知网、万方数据库、维普中文科技期刊数据库的相关文献,检索时限为建库至2023年4月10日,并对纳入文献进行讨论分析。结果 共纳入33篇文献。结果显示,头颈癌患者身体意象的影响因素包括社会人口学特征、疾病治疗因素、心理和行为因素、其他因素。身体意象评估工具主要从身体意象相关的情感认知、生理功能、社会活动来进行评估。研究中头颈癌患者的干预措施主要包括美容修复技术、皮肤伪装计划、运动疗法、认知行为干预、表达性写作、积极心理干预。结论 身体意象的影响因素还需进一步探讨,未来研究应选择科学的评估工具,并在此基础上开展干预性研究,改善头颈癌患者身体意象水平。

头颈部肿瘤患者放射性皮炎预防及管理的最佳证据总结

目的 系统检索、评价和总结头颈部肿瘤患者放射性皮炎预防及管理的最新最佳证据,为临床制定个性化的皮肤管理方案提供循证依据。方法 计算机检索各指南及专业协会网站、Cochrane图书馆、JBI循证护理数据库、PubMed、CINAHL、Web of Science Core Collection、Embase、中国知网、维普数据库、万方数据库、中国生物医学文献数据库中所有关于头颈部肿瘤放射性皮炎预防及管理的文献,包括指南、专家共识、系统评价、最佳实践信息册等。检索时间为建库至2023年8月23日。结果 共纳入22篇文献,包括1篇指南、4篇专家共识、17篇系统评价或meta分析。从头颈部肿瘤患者放射性皮炎的发病率、危险因素、临床表现、评估监测、健康教育、日常护理、预防及治疗措施、感染控制、管理策略9个方面总结出43条证据。结论 头颈部肿瘤患者放射性皮炎预防及管理的最佳证据为医疗保健人员制定个性化皮肤管理方案提供循证依据,临床实践过程中需结合具体情境和患者个人意愿选择证据。

头颈部肿瘤患者家庭抗逆力的潜在剖面分析及其影响因素

目的 了解头颈部肿瘤患者家庭抗逆力特征的分类,并分析不同类别的影响因素。方法 采用便利抽样,选取2021年12月-2022年12月上海质子重离子医院接受治疗的316例头颈部肿瘤患者为研究对象,采用自编一般资料调查问卷和家庭弹性评定量表中文简化版(FRAS-C)分别收集患者一般资料和家庭抗逆力资料。采用潜在剖面分析识别家庭抗逆力特征得类别,采用多元logistic回归分析不同类别的影响因素。结果 头颈部肿瘤患者家庭抗逆力特征分为3个类别:低家庭抗逆力型(10.8%)、高抗逆力-低资源利用型(24.0%)和中等家庭抗逆力型(65.2%)。文化程度、家庭年收入、是否与照顾者同住、子女个数和病程是头颈部肿瘤患者家庭抗逆力不同类别的影响因素(P<0.05)。结论 头颈部肿瘤患者家庭抗逆力特征存在异质性,医护人员可在了解患者社会人口学和疾病特征基础上预判家庭抗逆力特征,针对患者需求提供相应的护理服务,帮助成功应对肿瘤疾病。

医务人员对老年头颈癌患者实施术前预立医疗照护计划的观点:Q方法

目的调查头颈外科医务人员对老年头颈癌手术患者术前实施预立医疗照护计划的观点。方法采用Q方法,结合量性和质性方法探索和分析参与者的态度。参与者对半结构式访谈和文献综述产生的35个Q陈述进行排序,并在后续的半结构式访谈中解释排序原因,分析数据形成因子序列以说明参与者的观点。结果共有15名医务人员参与本研究,包括8名医生和7名护士。医务人员对术前实施预立医疗照护计划的观点各不相同,分为3类:维护患者的自主权,患者的知识和传统文化背景影响术前实施预立医疗照护计划,缺乏实施术前预立医疗照护计划的信心。结论尽管本研究中头颈外科医护人员能够认识到术前讨论预立医疗照护计划的益处,但患者认知水平的限制、传统文化价值观、医护人员能力不足及相关法律和政策不健全等因素导致这些医护人员对术前咨询和与患者讨论预立医疗照护计划存有疑虑。未来的研究应探讨克服术前预立医疗照护计划讨论障碍的策略。

同步放化疗期间头颈癌病人症状群与生活质量的相关性研究

目的:调查头颈癌病人同步放化疗期间症状群及生活质量,并分析两者之间的相关性。方法:采用一般资料调查表、安德森症状评估量表-头颈部模块、头颈癌生活质量量表,对安徽省某三甲医院134例同步放化疗期间头颈癌病人进行调查。结果:通过因子分析提炼出头颈放疗特异性症状群、进食障碍症状群、病感行为症状群、心理情绪症状群、胃肠道症状群5组症状群,累积方差贡献率达72.21%,其中头颈放疗特异性症状群尤为严重;病人生活质量总分为(82.95±9.01)分,处于较低水平;5组症状群与生活质量总分均呈负相关关系(P<0.05~P<0.01);回归分析显示,除胃肠道症状群外,其余4组症状群均为生活质量的负向预测因素(P<0.05~P<0.01)。结论:头颈癌病人同步放化疗期间存在多个影响生活质量的症状群,医护人员应及时准确识别并干预,尤其是头颈放疗特异性症状群,从而提高病人的生活质量。

Cutaneous ciliated cyst on the anterior neck in young women: A case report

BACKGROUND A cutaneous ciliated cyst(CCC)is a rare,benign tumor in young female adults,which is usually found on the lower extremities.CASE SUMMARY We found an uncommon location of CCC in the anterolateral cervical area and reviewed the literature.A 20-year-old female complained of a well-defined,painless,palpable mass that started several years ago.The mass was tense and movable and located at the anterolateral aspect of the neck.Imaging showed a non-enhancing round mass.Surgical excision biopsy was performed,and the cystic mass was revealed to be a CCC.CONCLUSION The rare location of CCC can be found in anterior neck area,which should be another diagnostic option for mass on anterior neck.

口腔颌面部肿瘤患者游离皮瓣修复术的并发症预防及处理

快速康复理念对于口腔颌面部肿瘤患者十分必要,特别是针对手术并发症较多的接受了游离皮瓣修复术的患者尤其重要。口腔颌面部肿瘤患者游离皮瓣修复术的快速康复中,手术并发症的预防及处理是其中的重要内容。本文结合部分文献回顾及笔者在临床实践中的经验进行总结,包括气道管理、出血控制、术后感染预防、游离皮瓣修复术相关的手术并发症预防以及口腔颌面部功能相关并发症的预防和治疗,供相关医务人员参考,以期提高患者术后恢复速度,加强快速康复理念在口腔颌面部肿瘤患者游离皮瓣修复术中的应用。

局部晚期头颈鳞状细胞癌诱导免疫治疗联合化疗探索研究

目的 探讨局部晚期头颈鳞状细胞癌(head and neck squamous carcinoma,HNSCC)应用程序性细胞死亡蛋白-1(programmed death-1,PD-1)抑制剂诱导免疫治疗联合化疗的近期疗效及安全性。方法 选择2020年5月-2022年5月济宁医学院附属医院肿瘤科初诊不可手术切除的局部晚期HNSCC患者25例,所有患者接受PD-1抑制剂诱导免疫治疗联合化疗3个周期,具体用法:PD-1抑制剂200 mg,每3周为1个周期,化疗方案为铂类联合紫杉类化疗药物(不适合铂类或紫杉类患者调整为氟尿嘧啶、吉西他滨)。3个周期诱导化疗后采用实体瘤疗效评价标准(RECIST1.1)评估近期疗效,根据PD-L1表达分层分析每亚组疗效分析,另外对治疗相关不良反应进行分析。结果 25例患者中疗效评价部分缓解(PR)21例(84%),其中肿瘤体积缩小≥50%为15例(60%),客观缓解率(ORR)为84%,疾病控制率(DCR)为88%。16例患者进行了联合阳性分数(combined positive score,CPS)检测评估PD-L1表达情况,CPS≥5占50.0%(8/16),其中CPS≥20占25.0%(4/16),另外9例患者未能行CPS检测而PD-L1表达不明。根据PD-L1表达分层分析来看,5≤CPS<20和CPS≥20的患者,肿瘤体积缩小均≥50%,ORR为100%,而CPS<5的所有患者中1例PR肿瘤体积缩小≥50%,PD为2例,ORR为62.5%(5/8)。最常见的不良反应为恶心、白细胞减少和贫血。3例患者出现甲功异常,1例肾功能损害,2例肝功能损害,2例肺炎患者。无3-4级不良反应。结论 局部晚期HNSCC,尤其IVA/IVB期患者,诱导免疫治疗(PD-1抑制剂)联合化疗近期疗效明显,对于CPS≥5的患者疗效更显著,无严重毒副反应发生,有望成为局部晚期头颈部鳞癌新的治疗模式。

3种软件在头颈部肿瘤患者脑干结构自动勾画中的应用比较

目的 比较PVMED-iCurve、AccuContour和DeepViewer 3种国产软件自动勾画头颈部肿瘤患者脑干结构的准确性。方法 选取2021年1月至2022年10月收治的20例头颈部肿瘤患者为研究对象,分别使用PVMED-iCurve、AccuContour以及DeepViewer3种软件自动勾画头颈部肿瘤患者脑干结构。以手动勾画作为参考标准,通过对比上述3种自动勾画的体积差异(△V%)、Hausdorff距离(Hausdorff Distance,HD)和Dice相似性系数(Dice Similarity Coefficient,DSC),评估3种软件自动勾画脑干结构的效果。结果 PVMED-iCurve、AccuContour和DeepViewer 3种软件自动勾画头颈部肿瘤患者脑干结构的ΔV%分别为6.01%±17.77%、-2.49%±9.33%以及-9.68%±11.17%;HD分别为(7.74±3.05)、(2.83±1.18)、(4.00±2.16)mm;DSC分别为0.81±0.05、0.89±0.05以及0.85±0.06。3种软件两两比较,DSC差异均有统计学意义(P<0.05)。结论 3种软件自动勾画头颈部肿瘤患者脑干结构,均能达到较好的勾画效果。3种软件比较,AccuContour在自动勾画脑干的体积、位置和形状方面最好。

XRCC1、XRCC3、ERCC2多态性与头颈部肿瘤患者放射性甲状腺功能异常风险的相关性

目的:探讨XRCC1、XRCC3、ERCC2多态性与头颈部肿瘤患者放射性甲状腺功能异常风险的相关性。方法:选择2019年5月~2020年12月于新疆维吾尔自治区人民医院行强调放射治疗的头颈部肿瘤患者120例作为研究对象。所有患者于放射治疗开始前收集临床资料,并抽取空腹静脉血对XRCC1、XRCC3、ERCC2多态性情况进行分析。强调放射治疗结束后进行为期1年的随访并统计随访期间出现甲状腺功能异常的情况。最后根据甲状腺功能异常情况对患者进行分组,分析XRCC1、XRCC3、ERCC2多态性与患者甲状腺功能异常的相关性。结果:异常组患者女性占比高于正常组(P<0.05)。异常组患者XRCC1单核甘酸多态性位点rs25487、rs1799782、XRCC3单核甘酸多态性位点rs861539及ERCC2单核甘酸多态性位点rs1799793基因型分布差异具有统计学意义(P<0.05)。异常组患者XRCC1单核甘酸多态性位点rs25487的G基因型频率、rs1799782的T基因型频率、XRCC3单核甘酸多态性位点rs861539的T基因型频率及ERCC2单核甘酸多态性位点rs1799793的T基因型频率高于正常组(P<0.05)。女性、XRCC1(rs25487、rs1799782)基因分型、XRCC3(rs861539)基因分型、ERCC2(rs1799793)基因分型均为放疗后甲状腺功能异常的独立影响因素(P<0.05)。结论:XRCC1、XRCC3、ERCC2基因多态性与头颈部肿瘤患者放射治疗后甲状腺功能损伤存在相关性,可以进一步探讨其作为放射后甲状腺功能异常预测因子的可能性。

65例头颈部恶性肿瘤根治术后急性肺血栓栓塞症临床分析

目的:探讨头颈部恶性肿瘤患者术后急性肺血栓栓塞症(pulmonary thromboembolism,PTE)的临床特点与相关危险因素。方法:前瞻性纳入接受头颈部恶性肿瘤根治术的患者65例,记录患者基本特征、手术时间、卧床时间、凝血功能、深静脉血栓及PTE发生情况和处理方法等相关资料,探讨以上指标与头颈部恶性肿瘤根治术后PTE发生情况的相关性。采用SPSS 25.0软件包对数据进行统计学分析。结果:经肺动脉CT血管造影术(CT angiography,CTA)等相关检查,65例患者中,18例(27.7%)确诊为PTE,其中3例(4.6%)具有明显临床表现。呼吸困难、胸痛、咳嗽为PTE患者的主要临床症状,心动过速、血氧饱和度降低、呼吸频率加快、呼吸啰音是PTE患者最常见的体征。术后最高D二聚体与卧床时间过长,是头颈部恶性肿瘤根治术后发生PTE的重要危险因素。结论:头颈部恶性肿瘤根治术后围术期急性PTE发生率较高,临床表现及体征缺乏典型性。对PTE患者进行早期诊断和早期干预,是改善预后的关键。