Flow Cytometric Analysis of DNA Content in Parotid Tumor and Its Contiguous Acini

Summary: To investigate the relationship between proliferative capacity of salivary gland cells in contiguous acini of parotid tumors and recurrent neoplasma, DNA contents of 30 fresh specimens of parotid were studied by using cytometry in tumors, normal and shallow or deep lobe acini of the masses. The results showed that the DI was 1. 369, S % 16. 95, PI 26. 18 in malignant tumors; DI was 1. 171, S % 12. 41, PI 15. 54 in recurrent pleomorphic adenoma; DI was 1. 141, S % 12. 74, PI 13. 07 in pleornorphic adenoma, DI was 0. 999, S % 5. 10, PI 8. 00 in normal acini. Analysis of variance showed there was a significant difference (P<0. 01 ). The average DNA contents of shallow on deep lobe of contiguous tumors was 1. 08 in DI, 10. 65 in S %, 13. 49 in PI in malignant tumor, 1. 06 in DI, 8. 96 in S % and 9. 85 in PI in pleomorphic adenoma, which were all higher than in normal acini (P>0. 05). It was concluded that the levels of DI and S % of parotid tumor and its contiguous acini are related to degree of malignancy or recurrent condition of the tumors, suggesting contiguous acini of parotid tumors had the strong capacity of proliferation, which might play an important role in recurrent or malignant change of the parotid tumors.

DIAGNOSTIC ULTRASOUND IMAGING OF PAROTID TUMOR

Sonography was performed on 104 cases with parotid tumors. The shape, boundary and internal echoes were related to the malignancy of the tumor. The diagnostic criteria of parotid tumors were proposed. The sonograms of 32 surgical specimens of parotid tumors were compared with histopathologic findings to investigate the pathologic bases of various sonograms. The boundary echoes were related to integrity of the capsule of the tumor. The internal echoes were related to internal structures of the tumor.

Evaluation of Preoperative Fine Needle Aspiration Accuracy in Diagnosis of Malignant Parotid Tumors

Objective: To evaluate the diagnostic accuracy of fine needle aspiration (FNA) in detecting malignant parotid tumors. Design: A retrospective study of cases series. Setting: Salmaniya Medical Complex, Otorhinolaryngology Department, Kingdom of Bahrain. Methods: A retrospective study was carried out, between January 2009 and December 2018, for all patients diagnosed with parotid tumors at the Department of Otorhinolaryngology, Head and Neck Surgery at Salmaniya Medical Complex, Manama, Kingdom of Bahrain. Data collection was made from medical records, I-seha and laboratory information system (LIS). 87 patients underwent parotidectomy, of which 30 were excluded due to unsatisfactory diagnoses or missing data. The results of fine needle aspirations were analyzed and compared with the corresponding histopathologic diagnosis. Estimation of sensitivity, specificity, negative predictive value, positive predictive value and accuracy of FNA were calculated. Results: Among the 57 evaluated cases, four cases were further excluded from the final analysis due to unsatisfactory FNA results, therefore only 53 cases remained. The mean age of patients was 48.6 ± 17.2 years. A concordance with histopathology results was observed. 47 cases were diagnosed as benign and five cases were malignant, however, 1 case was diagnosed as malignant by FNA, but not in histopathology. The overall diagnostic accuracy was 98.1% and the prevalence of parotid malignancy was 9.4%. Sensitivity and specificity were 100% and 97.9%, respectively. Positive predictive value was 83.3% while negative predictive value was 100%. Conclusion: Fine needle aspiration is a highly sensitive and specific test in evaluating malignant parotid gland tumors. It is useful and accurate, especially when used hand by hand with the clinical assessment and radiological findings.

Factors influencing Frey syndrome after parotidectomy with acellular dermal matrix

BACKGROUND Frey syndrome,also known as ototemporal nerve syndrome or gustatory sweating syndrome,is one of the most common complications of parotid gland surgery.This condition is characterized by abnormal sensations in the facial skin accompanied by episodes of flushing and sweating triggered by cognitive processes,visual stimuli,or eating.AIM To investigate the preventive effect of acellular dermal matrix(ADM)on Frey syndrome after parotid tumor resection and analyzed the effects of Frey syndrome across various surgical methods and other factors involved in parotid tumor resection.METHODS Retrospective data from 82 patients were analyzed to assess the correlation between sex,age,resection sample size,operation time,operation mode,ADM usage,and occurrence of postoperative Frey syndrome.RESULTS Among the 82 patients,the incidence of Frey syndrome was 56.1%.There were no significant differences in sex,age,or operation time between the two groups(P>0.05).However,there was a significant difference between ADM implantation and occurrence of Frey syndrome(P<0.05).ADM application could reduce the variation in the incidence of Frey syndrome across different operation modes.CONCLUSION ADM can effectively prevent Frey syndrome and delay its onset.

Indications and Results of Parotidectomies in the Orl Department of the Idrissa Pouye General Hospital in Dakar. Concerning 31 Cases

Introduction: The parotid tumors are benign or malignant, primary or secondary neoformations developed at the expense of the parotid gland. The aim of the present study was to describe the indications and results of parotidectomies in the ENT department of the Idrissa Pouye General Hospital in Dakar. Patients & Methods: We conducted a retrospective study between January 1, 2004 and December 31, 2012, including all patients who had been consulted for a parotid tumor with or without histological evidence collected in the otolaryngology and anatomy-pathology department of the Idrissa Pouye General Hospital in Dakar. Results: We collected 31 patient files. The mean age was 47.45 years, with extremes of 16 and 74 years. Females predominated, with a sex ratio of 0.82. Swelling of the parotid region was the main reason for consultation in 100% of cases. Parotidectomy was the most frequently performed procedure, accounting for 41.93%. Benign tumors accounted for 72% of cases, the majority being pleomorphic adenomas (50%). The outcome was favorable in 67.74% of cases. Conclusion: Management of parotid tumors at HOGIP would be improved by informing and educating patients to consult early, and by upgrading the technical platform.

Different histological subtypes of parotid gland tumors: CT findings and diagnostic strategy

AIM:To present computed tomography(CT) findings of different histological subtypes of parotid gland masses in detail and to establish diagnostic strategy.METHODS:From January 2009 to November 2011,56 patients were collected through the histopathology and Picture Archiving and Communication Systems records,which revealed 5 basal cell adenoma(BCA),16 pleomorphic adenoma(PA),25 Warthin's tumor(War-T),3 Kimura's disease(KD) and 7 parotid carcinoma(PCa) cases.All the CT images were retrospectively analyzed by two radiologists in consensus,based on their description of morphology(location,number,size,margin and fibrous capsule) and enhancement patterns of masses.In addition,the diagnostic efficiency of diagnostic strategy is tested.RESULTS:War-T and BCA patients' mean age was 59.9 ± 12.6 years and 58.4 ± 18.2 years;the significant difference was seen in War-T vs PA and BCA vs PA.About 40% of War-Ts presented with bilateral multifocal lesions,a higher ratio than others.Seventy two percent of War-Ts were limited to the superficial lobe,followed by BCA 60% and PA 40%.Vessel facing sign and enlarged lymph nodes were both frequent in War-T,which respectively accounts for 84% and 76% of cases.Rapid contrast enhancement and decreases were unique for War-T.BCA and PA showed obvious delayed enhancement.The diagnostic strategy of parotid gland tumor had a good diagnostic efficiency,with high accuracy,sensitivity and specificity.CONCLUSION:Determination of the histological subtypes of parotid gland masses might be possible based on CT findings and clinical data.A diagnostic strategy with high diagnostic efficiency was established.

Diffuse large B-cell lymphoma arising from follicular lymphoma with warthin’s tumor of the parotid gland-immunophenotypic and genetic features: A case report

BACKGROUND Warthin’s tumor(WT)is composed of several cysts that are lined with tall,bilayered oncocytic columnar cells and lymphoid stroma.Within WT,the two components rarely transform into carcinoma or lymphoma,and when it does,carcinoma is the most common type.Approximately 28 cases of lymphoma with WT have been reported,most of which were non-Hodgkin lymphomas,and only a few cases were Hodgkin lymphomas.In the present report,we studied a case of diffuse large B cell lymphoma(DLBCL)arising from follicular lymphoma(FL)with WT in the parotid gland and its immunophenotypic and genetic features.CASE SUMMARY A 67-year-old man presented with a slowly enlarging right cheek mass for 12 years,and the mass began to change in size over a 2-mo time period.Over time,the patient felt mild local pain and right cheek discomfort.His medical history included a hepatitis B virus infection for 20 years and 30 years of smoking.Gross examination of the excised specimen showed a gray-red and gray-white appearance and a soft texture lobulated external surface neoplasm that measured 9 cm×8 cm×7 cm and was well circumscribed by relative normal parotid gland tissue.In cross section,the cut surfaces of the neoplasm were multicystic and had a homogeneous scaly appearance.A small fluid was discovered in the cyst.Bilateral oxyphilic,cuboidal or polygonal epithelium cells and lymphoid intraparenchymal components were observed.Many medium-to large-sized lymphoid cells were observed diffusely in part of the neoplasm,and a few secondary lymphoid follicles were observed at the center or edge of the neoplasm.Immunohistochemical staining showed that the columnar oncocytic cells were positive for AE1/AE3;neoplastic cells located in coarctate follicular were positive for CD20,Pax-5,bcl-2 and bcl-6;and the adjacent diffusely medium-to large-sized lymphoid cells were positive for Pax-5,bcl-6,CD20,MUM-1,bcl-2 and CD79a.The bcl-6(3q27)break-apart rearrangement was observed,and an Epstein Barr virus test was negative in the tumor cells.The patient survived 6 months after being diagnosed without any treatment.CONCLUSION WT-associated lymphoma is a very rare neoplasm in the parotid gland.Most cases are B cell non-Hodgkin lymphomas and involve middle-age and older males.This case highlights the extremely rare association of DLBCL arising from FL with WT and the importance of deliberate evaluation of the WT intraparenchymal stroma.Molecular detection techniques have potential advantages in the diagnosis of lymphoma with WT.

T_(1)-mapping鉴别腮腺常见肿瘤的初探

目的:探讨T_(1)-mapping和分段读出DWI(RESOLVE-DWI)在腮腺常见肿瘤鉴别诊断中的价值。方法:回顾性分析2018年6月-2022年8月经病理证实的169例腮腺常见肿瘤患者的T_(1)-mapping及分段读出DWI资料。其中,多形性腺瘤85例,Warthin瘤32例,恶性肿瘤52例。测量并比较三组肿瘤的T_(1)及ADC值,运用受试者工作特征(ROC)曲线评价T_(1)、ADC及二者联合(T_(1)+ADC)对腮腺肿瘤的鉴别诊断价值。采用Delong检验比较各参数的AUC的差异。结果:三组肿瘤的T_(1)值和ADC值的差异均有统计学意义(P<0.001);组间两两比较,差异均有统计学意义(P<0.001);多形性腺瘤的T_(1)值及ADC值最高;恶性肿瘤次之,Warthin瘤最低。T_(1)和ADC鉴别多形性腺瘤与Warthin瘤、多形性腺瘤与恶性肿瘤、Warthin瘤与恶性肿瘤的AUC分别为0.914和0.997、0.664和0.869、0.835和0.695,Delong检验显示2个参数AUC的差异均无统计学意义(P>0.05)。T_(1)+ADC鉴别多形性腺瘤与Warthin瘤、多形性腺瘤与恶性肿瘤的AUC均显著高于T_(1)(1.000 vs.0.914、0.873 vs.0.664,P均<0.001);T_(1)+ADC鉴别Warthin瘤与恶性肿瘤的AUC显著高于T_(1)(0.895 vs.0.835,P<0.001)和ADC(0.895 vs.0.695,P<0.001)。结论:T_(1)-mapping和RESOLVE-DWI有助于鉴别诊断腮腺常见肿瘤,二者联合诊断可提高鉴别诊断效能。

合成MRI定量弛豫参数对不同病理类型腮腺肿瘤的鉴别诊断

目的:探讨合成MRI定量弛豫参数对于腮腺常见肿瘤的鉴别诊断。方法:选择2022年5月至2023年1月郑州大学第一附属医院收治的腮腺肿瘤患者59例,均于治疗前行常规MRI和合成MRI,测量肿瘤全域弛豫参数[纵向弛豫时间(T1)、横向弛豫时间(T2)和质子密度(PD)]。比较腮腺多形性腺瘤组、Warthin瘤组和恶性肿瘤组T1、T2和PD。应用Bayes判别分析法对3种腮腺肿瘤进行分类。结果:腮腺多形性腺瘤、Warthin瘤和恶性肿瘤组T1、T2和PD的差异均有统计学意义(P均<0.001)。Warthin瘤组的T1和PD小于腮腺恶性肿瘤和多形性腺瘤组(P<0.05);腮腺多形性腺瘤组的T2大于恶性肿瘤和Warthin瘤组(P<0.05)。采用Bayes判别分析建立的诊断模型自身验证的准确率为61.0%,交叉验证的准确率为57.6%。结论:合成MRI定量弛豫参数对腮腺多形性腺瘤、Warthin瘤和恶性肿瘤的鉴别诊断有一定价值。

动脉自旋标记联合扩散张量成像对腮腺肿瘤的鉴别诊断价值

目的探讨应用动脉自旋标记(arterial spin labeling,ASL)和扩散张量成像(diffusion tensor imaging,DTI)评价多参数MRI在鉴别腮腺肿瘤中的临床价值。材料与方法回顾性分析滨州医学院附属医院2019年6月至2023年11月66名经手术病理证实的腮腺肿瘤患者,术前均行3D ASL和DTI,并测量肿瘤最大血流量(maximum tumor blood flow,TBFmax)和最小表观扩散系数(minimum apparent diffusion coefficient,ADCmin)、各向异性分数(fraction anisotropy,FA)。使用Mann-Whitney U检验或Kruskal-Wallis检验比较良性肿瘤(benign tumors,BT)和恶性肿瘤(malignant tumors,MT)的各参数值。使用受试者工作特征(receiver operating characteristic,ROC)曲线分析评估各参数和联合有差异的参数对腮腺肿瘤的诊断效能。结果66例腮腺肿瘤患者中,BT 55例[其中Warthin瘤(Warthin tumors,WT)15例,多形性腺瘤(pleomorphic adenomas,PA)23例,其他17例],MT11例。BT的FA值低于MT(0.13±0.06 vs.0.18±0.04,P=0.003)。PA的TBFmax值[(43.72±37.64)mL/(100 g·min^(-1))]低于MT[(92.56±58.26)mL/(100 g·min^(-1))](P<0.001)和WT[(145.26±64.54)mL/(100 g·min^(-1))](P=0.016)。PA的ADCmin值[(1.55±0.51)×10^(-3)mm^(2)/s]高于MT[(1.11±0.28)×10^(-3)mm^(2)/s](P=0.016)和WT[(1.03±0.53)×10^(-3)mm^(2)/s](P<0.001)。MT的FA值(0.18±0.05)高于PA(0.11±0.04)(P<0.001)和WT(0.12±0.02)(P=0.015)。FA鉴别腮腺BT与MT的曲线下面积(area under the curve,AUC)为0.78,敏感度、特异度分别为81.82%、70.18%。FA区分WT、PA与MT的AUC分别为0.85、0.87,敏感度分别为72.73%、100.00%,特异度分别为94.12%、65.22%。TBFmax、ADCmin鉴别WT与PA的AUC分别为0.90、0.85,敏感度分别为94.12%、95.65%,特异度分别为91.30%、82.35%。三者联合鉴别PA与MT的AUC可提高至0.98,敏感度为100.00%,特异度为86.96%。结论ASL联合DTI有助于鉴别诊断腮腺良恶性肿瘤,综合运用多参数各优势有助于区分WT、PA和MT。联合有差异的参数可显著提高区分PA与MT的诊断效能。

超声引导下微波消融治疗腮腺良性肿瘤的临床价值

目的 探讨超声引导下微波消融(MWA)治疗腮腺良性肿瘤的临床价值。方法 选取行超声引导下MWA治疗的18例腮腺良性肿瘤患者,比较MWA术后1、3、6、12个月肿瘤最大径、体积、体积缩小率及美容评分(CS)情况,并评估其治疗效果及与MWA相关的并发症;同时根据肿瘤的初始最大径分为≤2 cm、2~4 cm及>4 cm 3个亚组,比较各亚组MWA术前、后CS情况。结果 所有患者均成功治疗,随访期间均无复发。所有患者均于MWA术后出现面部轻度水肿,1例患者出现短暂性面神经损伤。MWA术后1、3、6、12个月腮腺肿瘤最大径分别为(2.56±1.49)cm、(2.26±1.26)cm、(1.67±1.05)cm、(1.47±1.01)cm;体积分别为2.68(0.87,6.16)cm^(3)、1.86(0.57,4.46)cm^(3)、1.15(0.19,1.91)cm^(3)、0.74(0.09,1.28)cm^(3);体积缩小率分别为37.20%±11.54%、57.48%±9.75%、81.20%±8.54%、90.01%±6.75%;患者CS分别为(2.83±0.79)分、(2.33±0.91)分、(1.89±0.90)分、(1.75±0.93)分;其中,MWA术后6、12个月腮腺肿瘤最大径和体积均较术前明显减小,MWA术后3、6、12个月体积缩小率均较MWA术后1个月明显减小,MWA术后3、6、12个月患者CS均较术前明显减小,差异均有统计学意义(均P<0.05)。亚组分析显示,≤2 cm组MWA术后1、3、6、12个月CS,以及2~4 cm组MWA术后3、6、12个月CS均较术前明显减小,差异均有统计学意义(均P<0.05);各亚组间同一时间CS比较差异均有统计学意义(均P<0.05)。结论 超声引导下MWA治疗腮腺良性肿瘤具有良好的临床疗效,且初始最大径较小的肿瘤术后CS减小更快,对患者进行早期干预可以获得更好的美容效果。

不同手术切口对腮腺良性肿瘤患者血清疼痛介质、氧化应激的影响

目的分析不同手术切口对腮腺良性肿瘤患者血清疼痛介质、氧化应激的影响。方法回顾性分析2016年1月至2023年1月在赞比亚Ndola教学医院、赞比亚恩都拉铜带大学教学医院、河南省人民医院、河南科技大学第二附属医院接受腮腺良性肿瘤切除手术治疗的65例腮腺良性肿瘤患者临床资料,按照手术切口分为对照组(40例,术中接受传统S形切口操作)、观察组[25例,术中行改良耳前-耳后发际切口(又称改良V形切口)]。对比两组手术指标、术区面神经损伤情况、血清疼痛介质、氧化应激指标、手术瘢痕情况、并发症发生率。结果观察组手术用时、术后引流量与对照组相比,差异无统计学意义(P>0.05);观察组术中出血量比对照组少(P<0.05);观察组术后第7天House-Brackmann分级法评分、超氧化物歧化酶、谷胱甘肽过氧化物酶比对照组高,血清前列腺素E 2、P物质、β-内啡肽水平比对照组低(P<0.05);观察组术后第1个月瘢痕美容评估与评级量表评分比对照组高(P<0.05);观察组并发症发生率与对照组比较,差异无统计学意义(P>0.05)。结论与传统S形切口操作相比,实施改良V形操作可有效减少术中出血量,减轻面部神经损伤程度,降低术后疼痛及氧化应激反应程度,改善手术瘢痕情况。

多参数MRI在腮腺多形性腺瘤和腺淋巴瘤中的诊断价值

目的 探讨临床及多参数MRI影像资料在腮腺多形性腺瘤(PA)和腺淋巴瘤(AL)中的诊断价值。方法回顾分析41例经病理证实为PA和AL患者的临床资料、3.0T常规MRI、DWI和增强扫描等多参数MRI影像资料,分析其临床差异及不同序列图像上病灶主要征象或参数值的诊断效能。结果 PA和AL在吸烟史、侧别、位置、病灶数量及ADC值等方面差异均有统计学意义(P<0.05)。PA好发于女性,多位于腮腺上极,AL好发于男性,常有吸烟病史,多位于腮腺下极,AL较PA发生在双侧、多发更为常见。PA平均ADC值为1.471×10^(-3)mm^(2)/s,显著高于AL的0.913×10^(-3)mm^(2)/s,两者的ADC值在统计上存在差异(P<0.001)。当ADC值为1.261×10^(-3)mm^(2)/s作为两者鉴别诊断的阈值时,敏感度为79.2%、特异度为88.2%,曲线下面积(AUC)为0.897。结论 多参数MRI影像资料结合临床资料在PA与AL的诊断和鉴别诊断中有一定价值。

探索基于增强CT影像组学鉴别良恶性腮腺肿瘤的应用价值

目的 利用增强CT影像组学特征构建影像组学模型并绘制列线图鉴别良恶性腮腺肿瘤。方法 回顾性分析山西白求恩医院行颌面部两期增强CT患者103例,所有患者经病理证实均为腮腺肿瘤(良性71例,恶性32例)。于两期增强CT图像手动勾画肿瘤ROI,提取组学特征采用LASSO降维筛选特征后计算出影像组学评分(rad-score)并建立影像组学预测模型并绘制列线图。采用ROC曲线对模型性能评估,通过实施Hosmer-Lemeshow适合度评估模型的统计拟合度并绘制了校正曲线(calibration curve)。采用决策曲线分析(decision curve analysis,DCA)进一步探讨模型的临床应用价值。结果 根据rad-score建立的LR模型在训练集和测试集的AUC分别为0.848(95%CI 0.24-0.931)和0.826(95%CI 0.711-0.925)。校准曲线显示出良好的一致性。决策曲线分析显示了显著净收益的增加。结论基于增强CT影像组学在鉴别良恶性腮腺肿瘤具有术前诊断价值,有助于临床精准诊疗。

异种脱细胞真皮基质组织补片置入对腮腺良性肿瘤患者术后味觉出汗综合征发生的影响

目的探讨异种脱细胞真皮基质组织补片(H-AMD)置入对腮腺良性肿瘤患者术后味觉出汗综合征(Frey综合征)的影响,以期为临床预防腮腺良性肿瘤患者术后发生Frey综合征提供参考。方法选取2018年3月—2021年12月在成都市中西医结合医院接受手术切除治疗的90例腮腺良性肿瘤患者,按照是否置入H-AMD分为对照组(44例)与研究组(46例)。比较2组患者手术及术后恢复相关指标、术区异物感及其他并发症发生情况、Frey综合征发生情况、美容满意度等。结果2组患者术中出血量、手术时间、引流管放置时间、住院时间比较,差异均无统计学意义(P>0.05)。2组患者术后术区异物感及面瘫、耳周麻木、唾液漏、感染、发热等并发症发生率比较,差异均无统计学意义(P>0.05)。研究组患者术后12个月内Frey综合征主观判定阳性率与客观判定阳性率均低于对照组,差异均有统计学意义(P<0.05)。研究组患者术后3个月、6个月时Frey综合征客观判定阳性率低于对照组,差异均有统计学意义(P<0.05);2组患者术后12个月时Frey综合征客观判定阳性率比较,差异无统计学意义(P>0.05)。研究组患者美容满意度优于对照组,差异有统计学意义(P<0.05)。结论H-AMD置入可有效降低腮腺良性肿瘤患者术后Frey综合征发生风险,提高患者美容满意度,且不会造成患者不适或增加其他并发症发生风险。

跨理论模型为指导的协同干预在腮腺肿瘤围手术期护理中的应用

目的探讨以跨理论模型为指导的协同干预在腮腺肿瘤患者围手术期中的应用效果。方法回顾性采集2021年1月至2022年12月信阳市中心医院收治的围手术期接受以跨理论模型为指导的协同干预的35例腮腺肿瘤患者临床资料,纳入干预组;采集同期围手术期接受协同干预的35例腮腺肿瘤患者临床资料,纳入对照组。分析两组临床资料,比较两组术前焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、一般自我效能感量表(GSES)评分、治疗依从性及术后并发症发生率。结果两组术前1 d SAS评分、SDS评分均较入院第1天降低,且干预组术前SAS评分、SDS评分均低于对照组(P<0.05);两组出院前1 d GSES评分均较入院第1天升高,且干预组高于对照组(P<0.05);干预组治疗依从率高于对照组(P<0.05);干预组术后并发症总发生率5.71%(2/35),对照组术后并发症总发生率22.86%(8/35),干预组总发生率低于对照组(P<0.05)。结论以跨理论模型为指导的协同干预在腮腺肿瘤患者围手术期中的应用效果较佳,有利于改善患者术前焦虑、抑郁状态,提高自我效能感及治疗依从性,减少术后并发症的发生。

改良切口与传统切口治疗腮腺良性肿瘤的疗效比较

目的 基于多准则决策模型探讨改良切口与传统切口治疗腮腺良性肿瘤的疗效。方法 回顾性选择2019年4月至2022年4月于成都市中西医结合医院采用手术治疗的98例腮腺良性肿瘤患者为研究对象,将采用倒“V”型切口治疗的患者作为改良组,采用“S”形切口治疗的患者作为传统组,两组各49例。比较两组年龄、性别、病理结果、病变部位、手术时间、手术出血量等一般资料;比较两组视觉模拟评分法(VAS)评分、焦虑自评量表(SAS)评分、术后面瘫分级、术后3个月的疗效;比较两组面瘫、涎瘘等术后并发症发生情况。建立改良术式治疗腮腺良性肿瘤的多准则决策模型,并对两组效益值、风险值及决策模型的稳定性进行评价。结果 改良组患者的手术切口长度、术后皮肤表面瘢痕长度、VAS评分及SAS评分与传统组比较,差异均有统计学意义(P<0.05);改良组与传统组的平均效益值分别为83、55,改良组的效益值100%优于传统组;改良组与传统组的平均风险值分别为75、57,改良组的风险值100%低于传统组;改良组与传统组的平均效益-风险总值分别为79、56,改良组的总效益-风险值高于传统组的概率为100%;多准则决策评价模型稳定性较好。结论 倒“V”型切口能明显改善腮腺良性肿瘤患者术后面颈部的美观度,提高患者的生活质量及幸福指数。

应变弹性成像联合对比增强超声对腮腺良恶性肿瘤的诊断价值

目的探讨应变弹性成像(SE)联合对比增强超声(CEUS)对腮腺良恶性肿瘤的诊断价值。方法回顾性分析2015年2月至2023年5月于医院接受诊疗的327例腮腺肿瘤患者的临床资料。采集患者治疗前的SE和CEUS检查数据。根据活检或术后病理组织学检查结果将患者分为良性组(263例)和恶性组(64例)。比较两组性别、年龄、常规超声影像特征及SE、CEUS影像特征,并分析SE、CEUS单独及联合诊断腮腺良恶性肿瘤的灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)。结果两组病灶数量、最大直径、形态、边缘、回声特征、钙化情况比较,差异有统计学意义(P<0.05);两组SE评分、边缘增强清晰度、环状增强、增强大小、增强模式比较,差异有统计学意义(P<0.05);SE联合CEUS诊断腮腺良恶性肿瘤的灵敏度、特异度和PPV均高于SE、CEUS单独诊断,差异有统计学意义(P<0.05)。结论腮腺良恶性肿瘤的常规超声影像特征及SE、CEUS影像特征有所不同,SE、CEUS均对腮腺良恶性肿瘤具有一定诊断价值,联合诊断可提高诊断灵敏度、特异度和PPV。

区域性切除手术治疗腮腺混合瘤对患者面部神经和肌肉功能的影响

目的 探究区域性切除手术治疗腮腺混合瘤对患者面部神经和肌肉功能的影响情况。方法 前瞻性选取2020年3月至2022年3月在中国人民解放军北部战区总医院接受治疗的113例腮腺混合瘤患者为研究对象,按照随机数字表法将其分为对照组(n=56)和研究组(n=57)。对照组患者采用传统全腮腺切除术,研究组患者采用区域性切除术。比较两组患者临床指标(手术时间、术中出血量、切口长度、解剖面神经分支数)、术后面神经损伤情况、术后面部肌肉情况、腮腺分泌功能情况及不良反应发生情况。结果 研究组的手术时间、术中出血量、切口长度、解剖面神经分支数分别为(109.26±23.48) min、(52.16±5.98) mL、(9.41±2.49) cm、(2.19±0.35)支,均低于对照组[(146.06±23.15) min、(72.55±7.04) mL、(14.26±3.16) cm、(4.21±0.63)支],差异均有统计学意义(P<0.05)。研究组面神经颧支、颊支、下颌缘支功能损伤的发生率分别为5.26%、7.02%、8.77%,均低于对照组(57.14%、64.29%、98.21%),House-Back-mann面神经损伤分级评分为(1.78±0.66)分,低于对照组[(2.67±0.78)分],Portmann评分为(17.88±2.63)分,高于对照组[(13.65±3.15)分],差异均有统计学意义(P<0.05)。术前及术后3个月时,两组组间腮腺分泌功能比较,差异无统计学意义(P>0.05),术后6、12个月时,研究组患健侧腮腺分泌差值分别为15.59±5.11、16.02±5.46,均低于对照组(38.21±3.16、36.46±4.15),差异均有统计学意义(P<0.05)。研究组皮下积液、Frey综合征、面瘫及面部畸形的发生率分别为3.51%、10.53%、7.02%、7.02%,均低于对照组(21.43%、32.14%、26.79%、28.59%),差异均有统计学意义(P<0.05)。结论 区域性切除手术对腮腺混合瘤患者具有一定的优势,可以降低面部神经和肌肉功能损伤的风险,同时可以减少对腮腺功能的损害,降低并发症发生情况。

头颈部肿瘤容积旋转调强放疗治疗中靶区、腮腺剂量与体积变化研究

目的:探讨头颈部肿瘤容积旋转调强放疗(VMAT)治疗中靶区、腮腺剂量与体积变化情况。方法:选取2020年1月—2022年12月于贵州省人民医院肿瘤内科行VMAT治疗的头颈部肿瘤患者80例为研究对象,利用CT进行定位与检查,并用锥形束CT(CBCT)分析,分别测定计划CT、第10次CT、第22次CT,第10次CBCT、第22次CBCT时靶区(GTV、CTV)、腮腺(左侧、右侧)对应体积情况,并对靶区与危及器官随放疗进程的剂量学变化进行分析。结果:计划CT、第10次CT、第22次CT时,靶区GTV与CTV对应体积不断缩小,第10次CBCT、第22次CBCT时,靶区GTV与CTV对应体积不断缩小,差异有统计学意义(P<0.05);计划CT、第10次CT、第22次CT时,腮腺左侧与右侧对应体积不断缩小,同时第10次CBCT、第22次CBCT时,腮腺左侧与右侧对应体积不断缩小,差异有统计学意义(P<0.05);第10次、第22次CT时,脑转移瘤计划靶区(PGTV)对应2%剂量体积小于计划CT时,脑干最大照射剂量、腮腺平均剂量低于计划CT时,差异有统计学意义(P<0.05);计划CT与第10次、第22次CT时,PGTV对应95%体积剂量、脊髓最大照射剂量比较,差异无统计学意义(P>0.05)。结论:头颈部肿瘤患者VMAT治疗期间靶区与腮腺体积会明显减小,随着放疗时间延长,有必要设计二程放疗计划,同时为了提高靶区照射准确性、减少腮腺受照射剂量,可予以离线自适应性放疗技术处理。