Research Progress in Surgical Management of Head and Neck Tumors Involving the Carotid Artery

The surgeons adopt the comprehensive treatment method basing on surgery When head and neck tumors involve the carotid artery. At present, there are four surgical treatments, namely, dissection of carotid artery tumor, resection of carotid artery, revascularization after carotid resection, endoarterial implantation of covered stent combined with surgical resection. However, there is currently no consensus on the standard surgical approach to choose. This paper describes the four surgical methods, which are expected to be helpful for head and neck surgeons to choose the surgical methods for head and neck tumors involving the carotid artery.

Prototyping: Major Advance in Surgical Planning and Customizing Prostheses in Patients with Bone Tumors of the Head and Neck

Major resections of bone tumors of the head and neck, owing to their small dimensions and their proximity to the organs in this region, cause important functional and aesthetic problems that significantly compromise patients’ quality of life. Therefore, therapeutic planning should always extend beyond the resection to include functional and aesthetic reconstruction, preferably immediately. Microsurgical reconstruction represents a significant advance, but has not yet been perfected. Rapid prototyping (RP) comes as a new technology for the purpose of assisting the surgeon in the visual and tactile aspects of surgery, providing diagnostic accuracy and increasing the success of surgical planning. The authors demonstrate the technological advances in the manufacture of customized mandibular prostheses with the assistance of RP and practical applications of these methods.

ANALYSIS OF 26,826 PATIENTS WITH TUMORS IN THE HEAD AND NECK

A series of 26,826 patients with head and neck tumer as confirmed by pathology from January 1970 to December 1989 are analyzed. It accounted for 39. 5% of all the tumors blopsied in the same interval. In this series, 72. 4% was malignant which accounted for 45. 77% of malignant tumors in different parts of the whole body. For benign tumors in the head and neck, the ratio of male to female was 0. 84:1, and for malignant tumors In the head and neck it was 2. 4:1. The most frequently involved site by the malignant tumors were :nasopharynx, mouth, maxillofacial regions, and neck. THe majority (62. 65%) of malignant tumors were located in the nasopharynx which accounted for 28. 68% of all malignanties of which the ratio of mate and female was 3:1, peak age was 41-50 years, 18 of themwas under 10 years of age, the youngest was 1 1/2 years andthe oldest was 84 years old. These data showed that malignant tunors in the head and neck regions, expecially those in the nasopharynx, are common in Guanxi province, China. The program for cancer research on prevention and treatment should be enforced.

MANAGEMENT OF HEAD AND NECK TUMORS

The experience of management of head and neck tumors was summarized by author’s and some other Chinese literatures. This paper mainly introduced the epidemiology, diagnosis, treatment and prognosis of head and neck tumors, especially the malignancies in China. It emphasized that to assign protocols on a case-by-case basis (custom made) and the combined therapy are key points to improve the cure rate or survival rate for head and neck malighancies. Up to now, the 5-year survival rate for squamous cell carcinoma of head and neck was about 62% (1986), and about 71% (1987) for carcinoma of salivary gland origin.

A CLINICAL ANALYSIS OF 7878 PATIENTS WITH TUMORS IN THE HEAD AND NECK

7878 patients with tumors in the head and neck were analyzed in a period of twenty years. All the diagnosis were confirmed by pathologic examination. There were 5485 cases (69.62%) of malignant tumors. Nearly an half of malignant tumors were in the nasopharynx (49.32%). Among the malignant tumors of the nasopharynx, 2698 were carcinoma (99.34%) and only 18 (0.66%) sarcoma. Nine of them were under 10 years of age, the youngest patient was 3 years old, and this is rare in our county. The incidence of head and neck tumors was 37.66% and that of the head and neck malignancies was 26.22% of tumors in the whole body. This study indicates that incidence of malignant tumor in head and neck was rather higher, it is worth to improve ths procedure of treatment and prevention.

Clinicopathological and Prognostic Significance of Circulating Tumor Cells in Patients with Head and Neck Cancer: A Meta-Analysis

Purpose: The aim of the study was to evaluate the association between clinicopathological and prognostic significance and circulating tumor cells (CTCs) in patients with head and neck cancer. Methods: We searched PubMed, MEDLINE, BioMed, and EMbase databases for studies that assessed the association between clinicopathological and prognostic significance and CTCs in patients with head and neck cancer. Studies obtained from search strategy were screened using pre-specified criteria, and necessary data were retrieved for meta-analysis. Results: Seventeen studies with 816 patients were eligible for combined analysis. Presence of CTCs in peripheral blood was significantly associated with N stage (OR 0.50, 95%CI [0.30, 0.81], n = 10, P = 0.005). Patients in the high-CTC group were significantly associated with poorer disease-free survival (DFS;HR = 1.73, 95%CI [1.01 - 2.96], P = 0.050) and poorer overall survival (OS;HR = 2.53, 95%CI [1.37 - 4.69] P = 0.003). Further analyses indicated strong prognostic powers of CTCs in non-RT-PCR group and pre-treatment group. Conclusion: Our meta-analysis indicates that presence of CTCs is associated with higher N stage and poorer prognosis in patients with head and neck cancer. The potential for further clinical application may be needed for further investigation.Purpose: The aim of the study was to evaluate the association between clinicopathological and prognostic significance and circulating tumor cells (CTCs) in patients with head and neck cancer. Methods: We searched PubMed, MEDLINE, BioMed, and EMbase databases for studies that assessed the association between clinicopathological and prognostic significance and CTCs in patients with head and neck cancer. Studies obtained from search strategy were screened using pre-specified criteria, and necessary data were retrieved for meta-analysis. Results: Seventeen studies with 816 patients were eligible for combined analysis. Presence of CTCs in peripheral blood was significantly associated with N stage (OR 0.50, 95%CI [0.30, 0.81], n = 10, P = 0.005). Patients in the high-CTC group were significantly associated with poorer disease-free survival (DFS;HR = 1.73, 95%CI [1.01 - 2.96], P = 0.050) and poorer overall survival (OS;HR = 2.53, 95%CI [1.37 - 4.69] P = 0.003). Further analyses indicated strong prognostic powers of CTCs in non-RT-PCR group and pre-treatment group. Conclusion: Our meta-analysis indicates that presence of CTCs is associated with higher N stage and poorer prognosis in patients with head and neck cancer. The potential for further clinical application may be needed for further investigation.

Different imaging techniques in the head and neck:Assets and drawbacks

In this review,the gold standard imaging techniques for the head and neck and the latest upcoming techniques are presented,by comparing computed tomography(CT),magnetic resonance imaging and positron emission tomography-CT,as well as ultrasound,depending on the examined area.The advantages and disadvantages of each examination protocol are presented.This article illustrates the connection between the imaging technique and the examined area.Therefore,the head and neck area is divided into different sections such as bony structures,nervous system,mucous membranes and squamous epithelium,glandular tissue,and lymphatic tissue and vessels.Finally,the latest techniques in the field of head and neck imaging such as multidetector CT,dual-energy CT,flash CT,magnetic resonance angiography,spectroscopy,and diffusion tensor tractography using 3 tesla magnetic resonance are discussed.

头颈肿瘤围术期静脉血栓栓塞症防治中国专家共识

静脉血栓栓塞症(venous thromboembolism, VTE)是外科术后常见并发症和医院内非预期死亡的重要危险因素,也是恶性肿瘤患者的第二大死亡原因。晚期头颈部恶性肿瘤患者通常需要接受大范围的肿瘤根治手术和同期修复重建手术,又由于高龄兼长时间手术、术后长时间卧床以及肿瘤和化疗药物导致的血液高凝状态等多种危险因素,提示头颈部恶性肿瘤患者应是VTE的极高危群体,但相关文献对头颈部恶性肿瘤患者的VTE发生情况却很少关注,有关VTE在头颈肿瘤术后发生率的数据也有限。迄今为止,国内对于头颈肿瘤围术期静脉血栓栓塞症缺乏相关治疗共识或指南,不同单位对于头颈肿瘤围术期静脉血栓栓塞症的预防与管理水平参差不齐,缺乏统一、科学的诊疗标准及客观的预防与管理评价体系。为统一和规范头颈肿瘤围术期静脉血栓栓塞症的诊治,减少医疗资源浪费,提高治疗效果,国内该研究领域的专家经反复讨论,汇集全国14家著名医学院校及附属医院专家的诊治意见,同时借鉴和参考国内外近年来对头颈肿瘤围术期静脉血栓栓塞症的研究成果与诊治经验,制订本专家共识,供相关临床医师参考。

Primary Cutaneous Apocrine Carcinoma of the Neck Involving the Parotid Gland: A Case Report and Review of the Literature

Introduction: Primary cutaneous apocrine carcinoma (PCAC) is a rare skin malignant tumor that originates from areas with a high concentration of apocrine glands. The incidence of PCAC in the neck is relatively low. The age of onset in PCAC ranges from 5 to 70 years old. Clinically, PCAC typically shows up as painless nodules or lumps. In immunohistochemistry, positive expression of CK-7, GCDFP-15, AR, and myoepithelial markers are helpful in the diagnosis of PCAC. This case report pertains to a 59-year-old male of Asian descent. Five years ago, a painless mass was discovered behind his right ear, which grew slowly. This patient was identified as PCAC based on clinical symptoms, pathology, immunohistochemistry, and imaging characteristics. PCAC involved the parotid gland in this case;it is easy to be misdiagnosed as a primary malignant tumor of the parotid gland on imaging. Furthermore, a thorough set of clinical, imaging, pathological, and immunohistochemical examinations must be performed to make a diagnosis because it is challenging to differentiate PCAC from metastatic breast carcinoma. Conclusion: A well-developed multidisciplinary examination is essential because PCAC can be challenging to diagnose and differentiate.

小檗碱抗脑瘤和头颈部肿瘤的药理作用研究进展

小檗碱具有广泛的药理活性,除抗炎、抗感染、降血糖、调血脂、心脏保护等作用外,对胃癌、乳腺癌、膀胱癌、肝癌等还具有显著的抗肿瘤作用,是一个潜在的抗肿瘤药物。该文主要围绕小檗碱对甲状腺癌、鼻咽癌、口腔鳞癌、舌癌、喉癌、腺样囊性癌等头颈部肿瘤和脑癌的药理作用及其机制进行了综述和分析,为小檗碱的后续开发提供理论支撑。

头颈部恶性肿瘤患儿放化疗所致口腔黏膜炎的护理策略

目的通过有效的护理对策降低头颈部肿瘤患儿放化疗所致口腔黏膜炎(OM)的严重程度。方法选取2020年1月—2022年12月北京同仁医院儿科收治头颈部恶性肿瘤放化疗OM患儿,儿童口腔评估指南量表评分为9-16分的中度OM患儿100例,随机分为对照组和干预组,每组各50例,对照组根据医嘱用药,干预组在医嘱用药基础上加用(0-4)℃的0.9%生理盐水指导患儿在进食后、睡前、呕吐后、口腔黏膜炎用药前10分钟,利用双侧颊部运动形成水压涡流含漱,每次含漱口液10-15 mL,漱口≥30 s。干预3天后应用儿童口腔评估指南量表进行比较两组患儿口腔黏膜的严重程度及愈合时间、痛苦程度对比。结果干预组较对照组OM的严重程度明显减轻(χ^(2)=12.398,P=0.00);OM导致的痛苦程度干预组较对照组明显减轻(χ^(2)=5.263,P=0.02);OM愈合时间干预组较对照组明显短(χ^(2)=8.752,P=0.01)。结论儿童头颈部恶性肿瘤放化疗后口腔炎用生理盐水清洁口腔能明显降低OM的严重程度;减轻OM导致的痛苦;提高药物的治疗效果缩短OM的病程,具有临床推广价值。

三维适形调强放疗在头颈部肿瘤治疗中的临床应用

目的探究三维适形调强放疗在头颈部肿瘤治疗中的临床应用。方法方便选取2021年12月—2022年3月吉林省肿瘤医院收治的122例头颈部肿瘤患者为研究对象,随机抽签法分为对照组和观察组,对照组行三维适形放疗,观察组行三维适形调强放疗,并观察两组不同时间段症状、生活质量、临床疗效。结果观察组口干、疼痛、进食困难及吞咽困难等症状评分均优于对照组,差异有统计学意义(P均<0.05);观察组的不良反应发生情况少于对照组,差异有统计学意义(P<0.05);观察组的治疗总有效率为90.16%高于对照组的77.05%,差异有统计学意义(χ^(2)=4.659,P<0.05)。结论三维适形调强放疗,可以有效提升患者的生活质量,改善症状,减少肿瘤转移和复发率,全面提高治疗的价值。

ICARE互动教学法在头颈肿瘤内科护理教学中的应用效果分析

目的:分析ICARE(正直、同情、责任、尊重和卓越)互动教学法在头颈肿瘤内科护理教学中的应用价值。方法:选取2020年7月—2023年7月在广东省中医院芳村医院进行护理实习的76名护理实习生作为研究对象,根据教学方法不同将护理实习生分成ICARE组(n=38)和对照组(n=38)。两组护理实习生均由同一组带教老师教学,教学时间均为1个月。对照组采用传统教学法教学,ICARE组给予ICARE互动教学,比较两组的教学效果。结果:教学前,两组护理实习生的理论知识及实践能力得分比较,差异无统计学意义(P>0.05);教学1个月后,两组护理实习生的理论知识及实践能力得分均高于教学前,ICARE组理论知识及实践能力得分均高于对照组,差异有统计学意义(P<0.05)。教学前,两组护理实习生的头颈肿瘤内科护理综合能力得分比较,差异无统计学意义(P>0.05);教学1个月后,两组护理实习生的头颈肿瘤内科护理综合能力得分均高于教学前,ICARE组的头颈肿瘤内科护理综合能力得分高于对照组,差异有统计学意义(P<0.05)。教学前,两组护理实习生各项评判性思维能力评分比较,差异无统计学意义(P>0.05);教学1个月后,两组护理实习生各项评判性思维能力评分均高于教学前,ICARE组各项评判性思维能力评分均高于对照组,差异有统计学意义(P<0.05)。教学1个月后,ICARE护理实习生对教学的总满意度为97.37%,高于对照组的78.95%,差异有统计学意义(P<0.05)。结论:ICARE互动教学法在头颈肿瘤内科护理教学中的应用能提高护理实习生的理论知识、实践能力,改善护理实习生的评判性思维能力与综合能力,也可提高护理实习生的满意度。

尼妥珠单抗联合放化疗治疗局部晚期头颈部恶性肿瘤的临床效果

目的分析局部晚期头颈部恶性肿瘤实施尼妥珠单抗+放化疗治疗的价值。方法选取滕州市中心人民医院于2021年11月—2022年11月收治的72例局部晚期头颈部恶性肿瘤患者为研究对象,依掷骰子分为基础组和综合组,每组36例,基础组行放化疗,综合组加用尼妥珠单抗,对比两组的近远期疗效和不良反应。结果综合组的临床缓解率(58.33%),和临床控制率(88.89%)均高于基础组(30.56%、66.67%),差异有统计学意义(χ^(2)=5.625、5.143,P=0.018、0.023)。随访1年后综合组生存率(80.56%)高于基础组(58.33%),差异有统计学意义(P<0.05)。两组各项不良反应反应率比较,差异无统计学意义(P>0.05)。结论放化疗时辅以尼妥珠单抗治疗不会增加不良反应,且能维持高缓解率和控制率,提升远期生存率,适用于局部晚期头颈部恶性肿瘤患者。

个性化3D打印头枕对头颈部肿瘤放疗计划剂量学的影响

目的:评估不同材料的3D打印头枕对头颈部肿瘤放疗计划剂量学的影响。通过比较放疗计划靶区剂量、均匀性指数(HI)、适形度指数(CI)、机器跳数(MU)、危及器官剂量等参数的差异,评估3D打印个性化头枕在计划中是否可被忽略。方法:选择10例头颈部肿瘤患者,包括5例鼻咽癌患者和5例其他头颈部肿瘤患者。使用医科达Monaco计划系统勾画头枕轮廓,并在相同的计算参数下,计算忽略头枕、普通头枕、10%填充的聚乳酸(PLA)和聚氨酯弹性体(TPU)材料3D打印头枕对应的放疗计划。记录靶区剂量、危及器官剂量和MU等结果,并进行统计学分析。结果:在D_(95)、D_(5)、D_(mean)、HI、CI、MU、危及器官剂量(脊髓最大剂量)等参数上,忽略头枕、普通头枕、PLA和TPU材料3D打印头枕4组数据之间均无统计学意义(P>0.05)。在考虑头枕存在的情况下,对于鼻咽癌和其他头颈部肿瘤的分析结果显示,CI有统计学意义(P<0.05)。结论:在计划设计阶段,可以忽略3D打印个性化头枕的存在,但考虑到头枕的存在会降低放疗计划的MU。在考虑头枕的情况下,其他头颈部肿瘤患者的CI平均值显著高于鼻咽癌患者。

组蛋白乳酸化修饰在头颈肿瘤中的表达及意义

目的:观察组蛋白乳酸化修饰在头颈肿瘤中的表达水平及乳酸对肿瘤细胞增殖能力的影响。方法:应用多色免疫荧光组织芯片检测69例头颈肿瘤组织中泛乳酸化(PKLa)和组蛋白H3K9乳酸化(H3K9La)的修饰水平,分析其与患者临床特征的关系。在头颈肿瘤细胞受到乳酸刺激后,使用蛋白免疫印迹技术检测PKLa、H3K9La的修饰水平改变。采用SPSS 17.0软件包对数据进行统计学分析。结果:头颈肿瘤组织中PKLa修饰水平显著高于正常黏膜组织。临床样本分析表明PKLa修饰水平与年龄、TNM分期显著相关(P<0.05),而与性别、颈淋巴结转移、病理分化无相关性(P>0.05)。蛋白免疫印迹结果证明,组蛋白是头颈肿瘤细胞乳酸化主要的响应蛋白,乳酸刺激能够提高头颈肿瘤细胞增殖能力,进一步确定头颈肿瘤细胞中H3K9La修饰具有乳酸依赖上调。免疫荧光染色证明,头颈肿瘤组织H3K9La水平较高。结论:头颈肿瘤患者中具有较高的组蛋白乳酸化修饰水平,与头颈肿瘤进展有潜在关系。

头颈肿瘤免疫治疗病人居家自我管理体验的质性研究

目的:探讨头颈肿瘤免疫治疗病人居家期间自我管理的体验,为护理干预及管理提供参考。方法:采用目的抽样法,选取2023年2月-6月在长沙市某三级甲等医院肿瘤内科接受免疫治疗的18例头颈肿瘤病人,进行面对面半结构式访谈,采用Colaizzi 7步分析法进行资料分析。结果:头颈肿瘤免疫治疗病人的居家自我管理体验归纳为4个主题11个亚主题,居家自我管理能力缺陷(认知受限、技能不足、行为依从性弱)、居家自我管理支持资源匮乏(家庭支持不足、专业指导缺乏)、居家自我管理心理负担重(对副反应预后的不确定感、自我形象紊乱、病耻感增强)、居家自我管理的行为动力(同伴支持和医务人员支持、对个人健康及家庭的责任感、树立战胜疾病的信念)。结论:头颈肿瘤免疫治疗病人居家期间,护理人员需关注病人心理感受、生理体验及支持需求,提供更多针对性的指导和干预,提高其自我管理能力,以提升其生活质量。

面向头颈部肿瘤转移性淋巴结分割网络

头颈部肿瘤是我国常见的恶性肿瘤,其预后主要受颈部淋巴结转移的影响,医学上通过核磁共振成像技术对转移性淋巴结成像后再进行诊断,然而,核磁共振技术成像存在病灶形态信息丢失,病灶区域对比度低和病灶边界模糊的问题。针对这些问题,提出面向头颈部肿瘤转移性淋巴结分割网络协助医生进行诊断。首先,设计跨层跨视野注意力模块,其接收深浅层的特征信息后利用自注意力机制分别突显深浅层的转移淋巴形状,通过不同感受野的深层特征图学习到更好的语义上下文特征,将浅层特征图与深层特征图逐像素融合,增强转移淋巴病灶区域的形态信息。其次,设计多尺度特征融合模块,在特征金字塔的初始位置融合不同尺度的特征图,丰富转移淋巴病灶区域的形态信息。然后,设计增强注意力预测头模块,通过对预测前的特征图使用并行的自注意力与门控通道转换模块,凸出病灶区域,细化病灶边界。最后,使用临床淋巴结转移医学图像数据集验证网络的有效性。实验结果表明,所提网络对于淋巴结转移病灶分割的APdet,APseg,ARdet,ARseg,mAPdet和mAPseg分别为74.88%,74.12%,63.11%,62.28%,74.64%和74.04%。该网络实现对淋巴结转移病灶区域的精确检测分割,对辅助淋巴结诊断具有积极意义。

新确诊头颈肿瘤患者治疗前支持性照护需求现状及其影响因素研究

目的:探究新确诊头颈肿瘤患者治疗前支持性照护需求现状并分析影响因素,为制定相关照护方案提供依据。方法:采用一般资料问卷、癌症患者支持性照护需求量表(SCNS-SF34)、安德森头颈症状调查表(MDASI-H&N)、社会支持量表(SSRS)及医院焦虑抑郁量表(HADS)对184例头颈肿瘤患者进行调查。结果:支持性照护需求得分前3位的维度为生理和日常生活需求(2.95±0.75)分、医疗服务与信息需求(2.92±0.46)分、心理需求(2.64±0.65)分。多元线性回归分析显示,职业、疾病部位、治疗方式、社会支持、焦虑、症状负担是支持性照护各维度需求的影响因素(P<0.05)。结论:新确诊头颈肿瘤患者治疗前生理和日常生活需求、医疗服务与信息需求、心理需求较高。医护人员应重点依据职业、疾病部位、治疗方式、社会支持、焦虑、症状负担状况制定并调整支持性照护方案,以提高患者支持性照护需求满足度。

温通刮痧法对头颈癌放疗后吞咽障碍的临床疗效观察

目的 探讨温通刮痧法在头颈部肿瘤(HNC)放疗后吞咽障碍患者中的治疗效果。方法 选取2021年6月至2023年5月厦门市中医院康复科收治的HNC放疗后吞咽障碍患者60例,采用随机抽签法分为对照组(30例)、观察组(30例),对照组采用常规康复疗法,观察组在此基础上采用温通刮痧疗法。运用电视荧光吞咽检查(VFSS)记录咽期通过时间及电子鼻咽喉镜吞咽功能检查(FEES)评估渗漏误吸量表(PAS)来比较两组治疗前后的吞咽功能,运用吞咽生命质量量表(SWAL-QOL)评定患者生存质量,同时记录吸入性肺炎发生率。结果 治疗后,两组患者的吞咽功能、生命质量均较前改善(P <0.05);组间比较发现,观察组VFSS咽期通过时间短于对照组(P <0.05),PAS评分低于对照组(P <0.05),SWAL-QOL评分高于对照组(P <0.05);两组吸入性肺炎发生率比较,无显著差异(P> 0.05)。结论 温通刮痧疗法能有效改善HNC放疗后吞咽障碍患者的吞咽功能,并提高其生存质量。