OBJECTIVE: To explore the principles of donor site selection for defects of the hypopharynx and/or cervical-esophagus based on a novel defect classification system and treatment outcome of this series. METHOD: Thirty-nine patients underwent reconstruction of their defects of the hypopharynx and/or cervical-esophagus from January 2007 to June 2012 were retrospectively studied. 23 hypopharngeal and/or cervical-esophageal defects were circumferential or near circumferential (group A), 16 were partial(group B). 22 patients had compromised neck vascular status, while the other 17 patients had normal neck vascular status. Selection of the donor sites was based on extent of the defects and neck vascular status. Donor sites for reconstruction of the defects of group A included anterolateral thigh flap (n = 8), gastric pull-up (n = 6), radial forearm flap (n = 3), jejunum flap (n = 3), and pectoralis major myocutaneous flap (n = 3). For goup B, Infrahyoid myocutaceous flaps, radial forearm flaps, and pectoralis major myocutaneous flaps were used in 8, 3, and 5 cases, respectively. Flap survival, surgical complications, function outcome, and tumor control were observed. RESULT: Overall complication rate was 12.8% (5/39) in this series. In group A, three flap necroses occurred in jejunum flap (n = 1), anterolateral thigh flap (n = 1), and pectoralis major flap (n = 1). All these flap necroses occurred in the compromised neck vascular status group. One case of pharyngeal fistula without flap necrosis occurred in Group B. All except 2 patients restored oral intake postoperatively; 16 patients with laryngeal preservation had good phonation postoperatively. 2-year and 3-year survival of this series were 72.1% and 65.2%, respectively. CONCLUSION Selection of an appropriate donor site for reconstruction of the defects of hypopharynx and /or cervical-esophagus should be based on the extent of the defects, neck vascular status, and clinical features of the flap. Individualized donor site selection for hypopharyngeal and cervical esophageal defects reconstruction can result in good clinical outcome.
Adult ; Aged ; Esophagoplasty ; methods ; Esophagus ; surgery ; Graft Survival ; Humans ; Hypopharynx ; surgery ; Male ; Middle Aged ; Neck ; blood supply ; Necrosis ; Retrospective Studies ; Surgical Flaps ; pathology ; Transplant Donor Site ; anatomy & histology ; Treatment Outcome

Objective To explore the relationships between cholangiocarcinoma and clonorochiasis or hepatolithiasis,and to compare their MRI features.Methods The MRI features in 37 patients with cholangiocarcinoma confirmed by surgery and pathology were retrospectively analyzed,including clonorchiasis with cholangiocarcinoma in 21 (group A)and hepatolithiasis with this tumor in 16 (group B).The analyzed parameters included the location,size,shape,signal intensity and enhancement pattern of the tumor and the characteristics of bile duct dilatation.Results In group A,the tumors were located in the right lobe in 12 (57.2%),left lobe in 4 (19%),and porta hepatic in 5 (23.8%).In group B,those were located in the right lobe in 3 (18.7%),left lobe in 9 (56.3%),and porta hepatic in 4 (25%).There was a significant difference in the left/right lobe between two groups (P<0.05),however,no significant difference was found in porta hepatic (P>0.05).The MRI showed the tumors with low signal on T1 WI and high or heterogeneous signal on T2 WI,and with peripheral enhancement in early stage and delayed centric enhancement in 34 patients.Diffuse saccular dilatations of terminal intrahepatic bile ducts were showed in 1 6 (7 6 .2%)in group A and 1 (6 .2%)in group B,meanwhile the dilatations of bile ducts within tumors were showed in 2 (9.5%)in group A and 13 (81.3%)in group B,exhibiting significant differences between the two groups (P<0.05).Conclusion Clonorochiasis and hepatolithiasis are related with the cholangiocarcinoma.No differences in MRI features of cholangiocarcinoma are found between the two groups,however significant differences in location and the features of bile duct dilatation are observed.

Objective To compare the treatment outcome of underwent surgery plus radiotherapy and radiotherapy/chemoradiotherapy plus salvage surgery for stage Ⅲ/Ⅳ laryngeal carcinoma,to investigate an optimized treatment for the patients of stage Ⅲ/Ⅳ laryngeal carcinoma.Methods Clinical data from 103 patients with stage Ⅲ (39 cases) or stage Ⅳ (64 cases) laryngeal carcinoma were retrospectively analyzed.The patients were divided into surgery plus radiotherapy group (S±R,46 cases) and radiotherapy/chemoradiotherapy plus salvage surgery group (R±S,57 cases).Overall survival,relapse free survival,and laryngeal preservation rate were used to compare the treatment outcome between two groups.Multivariate regression models were used to analyze the independent factors for survival and laryngeal preservation rate.Results Survival rate was higher in S±R group than in R±S group [2 year overall survival/relapse free survival 74.7 ％ (34/46) / 72.4 ％ (33/46) vs 46.4 ％ (26/57) / 40.9 ％ (23/57),P ＜ 0.05].Laryngeal preservation rate was higher in R±S group than in S±R group [93.0 ％ (15/46) vs 32.6 ％ (53/57),P ＜ 0.05].Multivariate analysis demonstrated that treatment modality and T stage were independent factors for long-term survival,while treatment modality was the only an independent factor for laryngeal preservation rate.Conclusions Surgery plus radiotherapy result in better survival and lower laryngeal preservation rate than radiotherapy/chemoradiotherapy plus salvage surgery in treatment of stage Ⅲ/Ⅳ laryngeal carcinoma.Surgery plus radiotherapy should be the first choice for treatment of locally advanced laryngeal carcinoma.Improvement of the quality of life could be achieved by laryngeal preservation surgery and phonation reconstruction procedures.

[ABSTRACT]OBJECTIVEThis study was designed to compare the quality of life between patients who
underwent a tongue reconstruction with radial forearm flap (RFF) and infrahyoid myocutaneous flap (IHMCF) after hemiglossectomy for their tongue cancers, and to figure out an optimal reconstructive method for the defects resulted from hemiglossectomy.METHODSA non-randomized case-control study was performed on 24 patients with tongue squamous cell carcinoma who underwent a standard hemiglossectomy combined with perfectly tongue reconstruction from June 2005 to June 2012. All of the cases were without tongue base invasion. Of the 24 cases, 19 had T2 disease, 5 had T3 disease, and they were divided into RFF group (n=10) and IHMCF group (n=14). The quality of life were evaluated one year after operation using EORTC-QLQ30 and FACT-H&N35 and compared between the two groups.RESULTSThe scores were comparable between the two group with regard to all domains of EORTC-QLQ30,with all P values>0.05.The scores of swallowing(P=0.005), speech (P=0.008), teeth (P=0.014), and cough (P=0.009) domains were significantly higher in IHMCF group than in RFF group, with P value of 0.005, 0.008, 0.014 and 0.009 respectively, while the other domains of FACT-H&N35 were comparable between the two groups, with allP values>0.05.CONCLUSIONOverall quality of life was similar in the two groups. Oral function domains were better in IHMCF group than in RFF group. When guarantee of flap survival is available, IHMCF could be used as a good alternative flap to RFF in tongue reconstruction after hemiglossectomy.

Objective To report the clinical results and the advantages/disadvantages of anterolateral thigh flap (ALT) and forearm flap (FAF) in reconstruction of head and neck defect after cancer ablation. Methods 20 FAFs and 12 ALTs were performed to repair the head and neck tumor ablation defects. Of the 20 FAFs, 7 were used for repair of the through and through buccal defects, 4 for circumferential bypopharyngeal defects, 2 for plate defects, 1 for parotid area skin defect, 4 for floor of the mouth defects, and 2 for defect, of the base of the tongue, while of the 12 ALTs, 3 were used for repair of the defects of the base of the tongue, 4 for plate defects, and 5 for the floor of the mouth and/or lower gum defects. Survival of the flaps, function of the recipient site, and impact to the donor site were compared between these two groups to analyze the advantages/disadvantsges and key technique details of these two flaps. Results 19 FAFs totally survived. Vascular crisis occurred in 2 cases of FAF, of which 1 flap survived after conservative treatment, while the other 1 developed partial necrosis. All the 12 ALTs survived, without vascular crisis. 2 of the 14 planed ALTs were abandoned and replaced by FAFs, of which 1 because of absence of the perforating branch and the other 1 because of injury of the perforating branch. Secondary defects of the ALTs could be closed primarily, while secondary defects of the FAFs should be closed with skin grafts. Conlusion Both ALT and FAF can be performed with high survival rate. Each has its own advantages. Selection of the donor site deponds on situation of the defect and purpose of the reconstruction.

Objective To study the microsurgical anatomy of the extended transsphenoidal approach to the central skull base, and provide anatomical parameters for the surgical approach. Methods Forty wet skulls were dissected in detail via mimic extended transsphenoidal approaches under an operating microscope and an extended exposed operating microscope. Important structures and connections were observed, measured precisely and photographed. Dry skulls were used to observe and measure the osseous structures related to the approaches. Results The extended transsphenoidal approach can expand ahead, astern and laterally to the suprasellar intradural space by resecting bone and displaying the basafrontal lobe, pre-chaismatic space, optic chiasma cistern, anterior cerebral artery complex, the branches and cavernous sinus segment of the internal carotid artery, pons, basilar artery and its branches, posterior cerebral artery, and superior cerebellar artery. Conclusion The extended transsphenoidal approach can provide the new pathway for treating lesions of the central skull base.

Objective By combined application of endoscopic and microscopic vivisection-pronged approach,forms a three-dimensional morphological observation through focusing on an observation of structure of various signs, imaging features, morphology and measuring in vivo data, which are concerned with expansion of transsphenoidal approach. This will provide expansion of transsphenoidal approach with an intuitive morphological imagines,detailed anatomical parameters,accurate imaging data,viviperception and data measurement. Methods 80 patients were recruited for investigation, preoperative measurement of the size of the patient' s nose,height of nasal columella,the plane angle among bridge of nose,inner canthal of eyes and nose columella,and the length of bridge of nose.in the operation,measure the distance from nasal columella to aperture of sphenoidal sinus; observe the shape of aperture of sphenoidal sinus; measure the longest and the shortest distance between aperture of sphenoidal sinus; observe the shape of septum of sphenoidal sinus,three uplift and the relationship among them,as well as the color and texture of the tumor.Measure sphenoid sinus wall,screening room,sellar floor,extent of slope resection,operating space,as well as observation & study of selection and repairing of skull base reconstruction materials. Results The shape according to the discretion of the column is divided into butterfly saddle nose, normal nose, eagle nose and acromegaly hypertrophy nose.The nostrils shape is kidney form,ball form,snow humanoid formand triangle form.The butterfly saddle biggest digging distance:between the cavernous sinus is( 18.9±2.51 ) mm,from saddle nodules to slope is(19.2 ±2.67) mm.After tumor resection,the transsphenoidal observation space is forward to former group of ethmoid sinus,back to the slope. Conclusion The measurement data might be benefit for selecting of speculum, evalution of placing depth on speculum and operation position and sellar floor opening range. It would also make it possible for a safer, minimally invasive and effective surgery by avoid damage to the internal carotid artery,cavernous sinus or cranial nerve.

Purpose To assess the clinical application of non-contrast-enhanced MR angiography (NCE-MRA) using flow sensitive dephasing (FSD) prepared steady-state free precession (SSFP) for displaying hand arteries of patients with rheumatoid arthritis. Materials and Methods Twenty-two patients with rheumatoid arthritis were recruited in this study. All the patients undertook hand NCE-MRA and three-dimensional dynamic CE-MRA on a 1.5T MR scanner. The informed consent was obtained from each subject. Image quality was assessed independently by two experienced radiologists at three arterial segments (wrist arteries, palm arteries, andfinger arteries) with a four-point scale. Signal to noise ratio (SNR), contrast to noise ratio (CNR), and vessel sharpness were evaluated by a magnetic resonance physicist. The results and image quality were statistically compared between the two MRA techniques.Results Twenty-two patients of 24 hands successfully underwent NCE-MRA and CE-MRA scan. Among 72 vascular segments, 69 segments of NCE-MRA were diagnostic, which was higher than that of CE-MRA (96% vs 83%,P<0.05). Otherwise, the image quality, SNR, CNR and vessel sharpness of NCE-MRA were all superior to those of CE-MRA (P<0.05).Conclusion NCE-MRA using FSD-prepared SSFP allows clear depiction of the hand arterial tree, and the image quality is superior to that of dynamic CE-MRA. It is a potential tool for evaluating the disease of hand arteries.

ObjectiveTo compare the exposure, identification of parathyroid and postoperative complications between total thyroidectomy (TT) and subtotal/near total thyroidectomy (S/NT) for bilateral multiple thyroid nodules. MethodsA total of 278 cases were performed TT and S/NT randomly from Dec. 2006 to Dec.2009. The histology, identification of parathyroid and recurrent laryngeal nerves (RLN), and incidence of complications were compared between the 2 surgical procedures. The data were processed with t test or x2 test.Results227 cases were estimated to be benign preoperatively, among whom 28 cases ( 12.3％ ) were diagnosed as focal cancer by postoperative pathology. The identification rate of parathyroid was 96.5％ in TT group and 60.4％ in S/NT group (P＜0.05). The mean postoperative serum calcium level was 2.057 +0.016 mmol/L in TT group and 2. 15 + 0.019 mmol/L in S/NT group (P ＜ 0.05 ). The incidence rate of transient hypoparathyroidism (HPT) was 16.9％ in TT group and 5.7％ in S/NT group (P＜0.05). There was no statistical difference between the 2 groups in terms of the incidence rate of permanent HPT and transient recurrent laryngeal nerves (RLN) palsy ( P ＞ 0.05 ). The incidence rate of permanent HPT was higher in reoperation cases ( 11.1％ ) than in primary surgery cases (0.0％) in TT group ( P ＜0.05 ). ConclusionBased on the accurate technique under microscope field, TT is a safe surgical procedure for primary surgery with bilateral multiple thyroid nodules.

[Objective]To explore the effect of HSYA on pro/anti-inflammatory cytokine′s levels and mRNA expression in peripheral blood of mice.with sepsis.[Methods]Dividing NIH mice into four groups,as normal group,sham group,CLP group and HSYA group,24 mice in each group. The CLP sepsis mouse model was established. HSYA(120 mg/kg)were injected intravenously at 12 h before the operation ,and 0 h and 12 h following CLP ,and other groups were given normal saline. observed the animals behavior changes,measured the levels WBC,PLT,ALT,AST,BUN in serum,detected the levels and mRNA expression of IL-6, IL-10 ,TNF-α in peripheral blood. cultured of peripheral blood bacteria loads.[Results]24 h after surgery ,mice in CLP group appeared furring,feces residues on anus etc. compared to normal group,sham group and HSYA group,WBC,PLT,ALT,AST, BUN,levels and mRNA expression of IL-6,IL-10,TNF-αshowed significant increases,it was also found that bacterial load was significant increased in model group.[Conclusions]HSYA has a therapeutic effect in mice with sepsis ,can reduce bacteria into the blood,and inhibit inflammatory mediators which caused tissue damage.