Preoperative Irradiation in the Treatment of Carcinoma of the Hypopharynx

The results of treatment of 230 cases of carcinoma of the hypopharynx seen at the University of Toronto and the Princess Margaret Hospital, between the years 1951 and 1963, are presented. The recommendations of the American Joint Committee have been followed in the classification of these tumours: 127 of the 230 were located in the pyriform sinuses.The overall five-year survival rate for lesions of the pyriform sinus was 9% as opposed to 20% for tumours in the other regions of the hypopharynx. Surgical treatment alone was used in 44 of these cases, and the five-year net survival figure was 23%. This compared favourably with the overall survival figure of 8% for those treated primarily by radiotherapy.Elective preoperative irradiation leads to improved survival rates. Palliation for Stage IV lesions should be achieved by radiography. The two-stage method of surgical reconstruction remains the surgical procedure of choice despite current enthusiasm for the use of visceral transplants.     

37 例老年胃癌合并胰腺受侵围手术期的临床治疗分析

目的:探讨老年胃癌合并胰腺受侵患者围手术期合并症及并发症发生率与其他老年胃癌患者间的差异,优化老年胃癌合并胰腺受侵患者围手术期临床治疗护理策略。方法:收集2005年2月至2009年10月前来我院治疗的37名年龄>65岁的老年胃癌合并胰腺受侵患者作为研究对象,设置相同年龄胃癌无胰腺受侵患者37例作为对照,收集详细临床资料,对两组间围手术期合并症发生情况进行卡方(x2)检验,通过采取不同临床治疗护理手段进一步施行干预(包括不同的手术方式及临床监测管理模式),再次采用x2检验比较两组术后并发症发生率,最后通过随访实现Kaplan-Meier生存分析。结果:老年胃癌合并胰腺受侵组(组Ⅰ)与老年胃癌无胰腺受侵组(组Ⅱ)术前总体合并症发生率并无显著统计学差异(P>0.05);各项合并症中仅有血红蛋白降低(<100g/L)、白蛋白降低(<35g/L)以及合并糖尿病的患病人数存有统计学意义(P=0.020,P=0.032,P=0.013);根据两组患病情况不同采取不同手术方式,两组死亡人数未见统计学意义(P>0.05);组Ⅰ术后并发症发生率为70.27%,低于组Ⅱ的86.49%,但两组未见明显统计学差异(P>0.05);比较两组功能性、心血管类并发症,两者间存在显著统计学差异(P=0.036,P=0.013);两组术后5年生存率比较无统计学差异(P=0.8308)。结论:需加强对老年晚期胃癌合并胰腺患者围手术期的临床治疗护理策略,采取适宜的手术治疗方式,可减少术后并发症及死亡的发生,提高患者生活质量。     

不明原因消化道出血的外科治疗

目的:探讨不明原因消化道出血的原因及在手术过程中的诊疗策略及技术,以提高不明原因消化道出血的诊治水平。方法:对我院自2002年3月至2010年10月被诊断为不明原因消化道出血23例患者进行回顾性分析,其均经外科手术治疗。结果:本组23例患者,治愈22例,1例死于多脏器功能衰竭,1例术后出现肠瘘,2例患者出现术后切口感染。均未再次出现出血。平均住院时间14.3天。结论:手术治疗是不明原因消化道出血治疗的最后的诊治手段,掌握相应手术策略及技术,可使更多的患者受益。     

Endotracheal Tube Perforation of the Hypopharynx

Perforation of the hypopharynx or esophagus is a serious though not often reported complication of endotracheal intubation. Only 12 cases had been reported before the eight which are presented here to emphasize this hazard of intubation. The early symptoms of perforation, which occurred during insertion of the tube, were: subcutaneous emphysema (seven patients), mediastinal emphysema (six), pneumothorax (two), cardiac arrest (one). One patient had no recognized early signs of perforation, but presented with an abscess of the mediastinum six weeks later. The site of perforation, determined by endoscopy in six patients, was the lateral hypopharynx in four, and the vallecula in two. The outcome of the eight perforations was as follows: two patients recovered on conservative management; in two, abscesses of the neck and in one an abscess of the mediastinum developed. All three recovered after drainage of the abscesses. Three patients died. Two outstanding characteristics of these eight cases were that in all of them intubation was attempted by physicians relatively inexperienced in the technique, and in all but one it was done in emergency. Since the use of intubation in emergency situations is increasing, all physicians in training should receive formal instruction in technique.