OBJECTIVES:To assess the value of carbon dioxide transoral laser microsurgery (CO2 TOLMS) for early-stage glottic cancer with special regard to involvement of the anterior commissure (AC). STUDY DESIGN:Single-center retrospective cohort study. SETTING:Grade-A tertiary hospital. METHODS:A retrospective analysis of patients with early-stage (Tis-T2) glottic cancer who underwent CO2 TOLMS. All patients had at least 2 years of follow-up. The univariate and multivariate survival analyses were used to identify the risk factors for recurrence and the Kaplan-Meier method was used to analyze OS and DSS rates. RESULTS:A total of 102 patients were included in the study. Eleven patients (10.78%) had recurrence. The univariate analysis showed that the recurrence was associated with the AC classification, T staging, tumor size, and tobacco use (P < .05). However, on multivariate analysis, the AC classification was the only independent risk factor for recurrence (P < .001, HR = 3.179). AC classification were distributed as follows: 59 (57.84%) AC0, 29 (28.43%) AC1, 8 (7.84%) AC2, and 6 (5.88%) AC3, 2-year/5-year OS and DSS rates were progressively reduced in the AC0, AC1, AC2, and AC3 groups (P < .001). At the same T staging, the OS rates incrementally decreased as the level of involvement of the AC became higher (P = .004). CONCLUSION:CO2 TOLMS is an effective treatment for early-stage glottic cancer. AC involvement is an independent risk factors for recurrence and poor prognosis. The AC classification system may be better at grading the prognosis of patients with early-stage glottic cancer and has prognostic value independent of T staging.

Objective:To investigate the clinicopathological features, imaging features, diagnosis, and prognosis of embryonal rhabdomyosarcoma (ERMS) in the maxillary sinus. Methods:The detailed clinical data of rare patients with embryonal ERMS of maxillary sinus admitted to our hospital were retrospectively analyzed, and the embryonal ERMS was confirmed by pathological examination and immunohistochemistry, and the relevant literature was reviewed. Results:A 58-year-old man was admitted to the hospital with the chief complaint of "numbness and swelling of the left cheek for 1 and a half months". Blood routine, biochemistry, paranasal sinus computed tomography, and magnetic resonance imaging were performed after admission, and the pathology showed ERMS. At present, it is generally in good condition. Pathological examination showed that the cells were all small and round. Immunohistochemistry showed Desmin (+) and Ki-67 (+70%). Conclusion:The early symptoms of ERMS of the maxillary sinus are atypical and diverse, with a high degree of malignancy, rapid progression, strong invasiveness, and poor prognosis. Early diagnosis and treatment should be based on clinical characteristics, imaging examination, and immunohistochemical results.

资料 患者女性,58岁.因感冒后持续性声音嘶哑1月余就诊于我科.发病期间无咽痛、吞咽困难、呼吸困难.既往有吸烟史40年.电子喉镜检查可见双侧声带全长突出息肉样物,左侧声带前中份上表面略隆起,表面光滑,附白色假膜样物.双侧声带运动良好,闭合差(图1A、B).频闪喉镜检查显示右侧声带全长见鱼腹样息肉样物,左侧声带前中份黏膜发白,双侧声带运动良好,闭合欠佳;右侧声带黏膜波存在,周期性差,左侧声带黏膜发白处黏膜波消失.临床诊断为"双侧声带息肉",于2019年10月28日行显微镜支撑喉镜下双侧声带息肉切除术.

目的 探讨我院中药健脾降逆方治疗反流性咽喉疾病(LPRD)的临床疗效.方法 根据反流症状指数评分量表(RSI>13)选取我院耳鼻喉科门诊2018年10月至2019年4月就诊患者中可疑LPRD患者57例,给予健脾降逆方治疗,疗程均为半月,记录治疗前、后各个症状及总的RSI分数的变化,用SPSS20.0进行分析.结果 57例患者治疗后,显效人数42人,有效人数4人,无效人数11人,总有效率为80.7％.各症状及总的RSI治疗后评分明显低于治疗前,治疗后评分与治疗前相比,P<0.05,差异有统计学意义.结论 中药健脾降逆方可有效缓解LPRD患者的症状,尤其对于持续清嗓、烦人的咳嗽及咽喉异物感这些症状的临床疗效较好,具有临床使用价值,值得推广.

气管食管瘘是指由于先天或后天获得性因素导致食管与气管之间形成瘘管.导致儿童后天获得性气管食管瘘的主要原因有气管异物、食管异物、先天性食管闭锁术后、食管狭窄扩张术后等[1].患儿可反复出现呼吸道感染、肺炎、肺不张,偶尔可合并支气管扩张,肺部感染迁延不愈,误诊、漏诊时间长[2].2018年我院收治1例儿童气管异物导致气管食管瘘患者,现报道如下.

1 临床资料 患者,女,20岁,因声嘶伴咳嗽1年,于2019-06-24就诊我院.患者自述口、鼻干燥,鼻腔内干痂阻塞,咳嗽时可咳出干痂,伴有活动后气短.曾就诊当地医院,按"咽喉炎"、"慢性鼻炎"治疗2个月,期间应用抗生素1个月(具体药物不详),症状无明显改善.病程中无低热、盗汗,无眼红、关节肿痛.查体:口咽黏膜光滑,无充血.鼻腔宽大,较多干痂堵塞.颈部未触及包块.电子鼻咽镜示(图1):双侧鼻腔宽大、有较多干痂,鼻咽部见脓性分泌物及干痂,喉腔内较多黏性分泌物.清嗓后,后连合可见干痂,双侧声带黏膜略萎缩,运动正常,闭合欠佳.鼻咽部病理:淋巴组织增生.鼻腔病理:鳞状细胞增生伴不全角化,上皮下间质内淋巴组织增生,见较多腺体.既往肺结核病史,外院检查结核分枝杆菌抗体、特异性抗原及结核感染T细胞斑点实验均为阴性.我院肺功能提示:轻度限制性肺通气功能障碍,小气道功能中度阻塞障碍.支气管灌洗:未检到抗酸杆菌及其他致病菌,未培养出念珠菌.灌洗液病理:见较多炎细胞,少量上皮细胞及噬细胞,部分上皮细胞增生、坏死,未见到异形细胞.初步除外结核和淋巴瘤,可疑自身免疫性疾病,故行血液实验室检查.白细胞8.9×109/L,免疫球蛋白G(imunoglobulin G,IgG)48.60 g/L,补体C 371.80 mg/dl,类风湿因子153.00 IU/ml,λ轻链1470.00 mg/dl,κ轻链 3910.00 mg/dl,抗SSA(+++),抗SSB(+++),52 kDa蛋白抗体(+++),核周型-ANCA阳性, c-ANCA阴性.肝肾功能正常.初步诊断为:干燥综合征.患者又到北京协和医院就诊,进一步完善肺部检查示肺间质病变,类风湿相关抗体检测.其中,抗RO-52(+++),血清电泳、抗原着色结果可疑阳性,确诊为干燥综合征,给予羟氯喹每次0.2 g,每日2次口服.甲泼尼龙片每次50 mg,每日1次口服,同时予以碳酸钙、骨化三醇补钙治疗.1周后加用环磷酰胺0.6 g,每2周1次,静点.因副作用较大,改用吗替麦考酚酯,肺间质病变明显改善,咳嗽症状好转,但仍有鼻干、口干,鼻内仍有结痂.

Objective: To explore the inhibitory and synergistic effects of 5-fluorouracil and curcumin on Hep-2 laryngeal cancer cells and clarify the effect of mesoporous silica nanoparticles as drug carriers. Methods: The inhibitory effects of 5-fluorouracil and curcumin on Hep-2 cells were detected using the CCK-8 assay. CompuSyn was used to calculate the synergistic effect of the 2 drugs. Flow cytometry was used to detect apoptosis and cell cycle arrest induced by 5-fluorouracil and curcumin. The drugs were loaded into mesoporous nanoparticles. Western blotting was used to detect the expression of related proteins after treatment. The growth of subcutaneous tumors in BALB/c nude after the intraperitoneal injection with drug-loaded mesoporous silica nanoparticles was recorded. Results: 5-Fluorouracil and curcumin synergistically induced apoptosis and cell cycle arrest in Hep-2 cells. Mesoporous silica nanoparticles as drug carriers enhanced the therapeutic effects of 5-fluorouracil and curcumin. Conclusions: Mesoporous silica nanoparticles are expected to be effective drug carriers that enhance the synergistic effects of 5-fluorouracil and curcumin on laryngeal cancer.

目的 研究探讨阻塞性睡眠呼吸暂停患者阻塞平面的多种评估方式间的相关性.方法 2019年10月16日～2020年10月20日就诊于吉林大学第二医院耳鼻咽喉头颈外科经便携式睡眠监测仪确诊为阻塞性睡眠呼吸暂停的27例拟手术患者.所有患者术前常规行电子纤维鼻咽喉镜下Müller's检查(Müller's maneuver,MM)、Friedman临床分型(Friedman score,Fs)、药物诱导睡眠内镜(drug-induced sleep endoscopy,DISE)来评估上气道阻塞情况,并进行VOTE评分.结果 MM中软腭和舌根平面阻塞率分别为92.59％和40.74％;DISE下软腭、口咽、舌根、会厌平面阻塞率分别为81.48％、88.89％、40.74％、62.96％.在软腭平面,MM、DISE检查结果具有一致性(55.56％),其中25.93％与Fs也具有一致性,结果有统计学意义(P<0.05);在MM、DISE检查结果不具有一致性的患者中,MM与Fs、DISE与Fs一致的分别占22.22％,18.52％;三者均不一致的占3.70％.结论 27例患者中,55.56％MM和DISE评估软腭平面阻塞具有一致性,但与Fs无明显一致性.因此,M M与DISE可作为指导评估阻塞平面的方式,Fs则可作为一种辅助方式参与评估.另外,与MM相比,DISE可发现更多平面阻塞,尤其是舌根或会厌平面的阻塞.临床上建议联合使用多种方式进行阻塞平面的评估.

颗粒细胞瘤(granular cell tumor,GCT)是一种病因不明确的软组织肿瘤,发生于声带的GCT较少见且临床表现无特异性,普通的喉镜等检查难以与声带息肉等区分,当声带GCT合并其他声带病变时,易单纯误诊为声带其他病变.我院收治声带颗粒细胞瘤合并声带息肉1例,现报道如下.

儿童OSAHS是一种常见的儿童疾病,其特点为睡眠时上呼吸道间歇性发生部分或完全性闭塞,致使气体交换困难、间歇性缺氧以及频繁觉醒、睡眠结构紊乱,对儿童全身多个系统产生负面影响,目前儿童OSAHS与多系统疾病的相关性研究较少,本文针对OSAHS对儿童颌面部发育、生长发育、代谢、心血管、认知功能影响及相关机制等方面的研究进展进行综述.

Obstructive sleep apnea syndrome (OSAS) is a common sleep-disordered breathing disorder. Owing to the pathophysiological changes associated with it, it can affect the whole body. In recent years, domestic and foreign research studies have focused on the relationship between OSAS and systemic diseases. A number of studies have confirmed that OSAS is an independent risk factor for various cardiovascular and respiratory diseases. Based on the current status of knowledge regarding OSAS acquired through domestic and foreign studies, this paper summarizes the clinical features, preferred treatment methods, and related basic research of OSAS-related respiratory and circulatory diseases. It provides a basis for the clinical diagnosis and comprehensive treatment of OSAS.

目的 建立慢性间歇低氧大鼠模型,探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与炎症反应、血管内皮损伤的关系.方法 20只大鼠随机分为常氧组和慢性间歇低氧(chronic intermittent hypoxia,CIH)组,CIH组大鼠置于间歇低氧舱8h/d.8周后处死大鼠,ELISA检测血清白细胞介素-10(IL-10)、人软骨糖蛋白39 (YKL-40)含量;HE染色观察主动脉血管内皮;免疫组化检测主动脉核因子KB (NF-κB)、YKL-40表达.结果 ①CIH组大鼠PO2、SaO2随舱内氧浓度变化改变;常氧组PO2、SaO2基本保持不变.②血清指标:CIH组IL-10浓度低于常氧组(P＜0.05),两组YKL-40浓度无统计学差异;HE染色:CIH组大鼠主动脉血管内皮损伤;免疫组化:CIH组NF-κB表达高于常氧组(P＜0.05);两组大鼠血管几乎无YKL-40表达.结论 CIH导致主动脉血管内皮损伤,其机制与炎症相关因子表达失衡有关.

2例主要症状为反复吸气性呼吸困难的患儿就诊于吉林大学第二医院耳鼻咽喉科，经过耳鼻咽喉检查、喉镜、三维CT、自身免疫性疾病相关检查，诊断为复发性多软骨炎。复发性多软骨炎在儿童中罕见。.

According to the requirements of teaching outline,the teaching and research section of otolaryngology head and neck surgery of the Second Hospital of Jilin University has established the clinical skill training and examination system on the basis of years of teaching experience,which has been made preliminary practice by the clinical interns.The teaching effect was so obvious that the clinical practice ability of the medical students was improved,the common diseases of otolaryngology head and neck surgery were mastered,the teaching quality was also improved,which laid a solid foundation to the cultivation of a qualified surgeon and provided a theoretical support of the medical education for our hospital and other colleges.

Accumulation of immunosuppressive protein programmed death-ligand 1 (PD-L1) has been documented in several cancers and contributes to the evasion of the host immune system. However, cancer cell-intrinsic signaling-dependent control of PD-L1 expression remains to be elucidated. Herein, we aimed to identify the let-7 family of microRNAs as candidates that up-regulate tumor cell PD-L1 expression and mediates immune evasion of head and neck squamous cell carcinoma (HNSCC). The expression of let-7 family and PD-L1 was quantified in HNSCC tissues and adjacent normal tissues. PD-L1 degradation was evaluated in HNSCC cells in response to elevated expressions of let-7a or let-7b. The regulation of let-7 family on PD-L1 degradation through a mechanism involving T-cell factor-4 (TCF-4) control of β-catenin/STT3 pathway was evaluated. Immune recognition of HNSCC in vivo was examined in subcutaneous tumor-bearing C3H mice in the presence of let-7a/b and/or CTLA-4 antibody. The let-7 family were significantly down-regulated in the context of HNSCC, sharing a negative correlation with PD-L1 expression. Glycosylated PD-L1 was detected in HNSCC cells, which was reduced by let-7a/b over-expression. TCF-4, the target of let-7a/b, activated the β-catenin/STT3 pathway and promoted PD-L1 degradation. In vivo analysis demonstrated that let-7a/b over-expression potentiated anticancer immunotherapy by CTLA-4 blockade. Taken together, our findings highlight targeting let-7 family as a potential strategy to enhance immune checkpoint therapy for HNSCC.

目的 评价显微镜下支撑喉镜下CO2激光治疗早期声门型喉癌的临床疗效、术后并发症、患者生存情况、复发相关因素以及术后嗓音功能恢复情况.方法 回顾性分析吉林大学第二医院耳鼻咽喉头颈外科2014年1月～2018年12月间收治的早期声门型喉癌患者40例,评价CO2激光手术的近期和远期临床疗效、术后并发症及复发相关因素、黏膜恢复情况以及嗓音功能恢复情况等.结果 对40例患者进行术后随访,随访时间6个月～5年,其中失访6例,随访者无死亡病例,术后半年出现远处转移1例,术后1年于对侧声带出现癌变1例,局部复发2例.术后创面完全愈合期为(3.2±0.3)个月.18例患者出现新生声带,与无声带新生组相比,嗓音质量具有显著差异.患者术后生存质量高,喉保留率达97.5％.术后并发症少,2例出现声带粘连,1例出现术后出血,2例出现舌体麻木,2例出现误咽及呛咳,余患者均未出现严重并发症.结论 CO2激光对于治疗早期声门型喉癌临床疗效显著,对患者病变范围准确评估后进行CO2激光下内镜下声带病变切除后喉功能保留率高、并发症少、复发率低、损伤小恢复快,术后患者生活质量及发音质量均明显提高,是早期声门型喉癌安全有效的治疗方法.

阻塞性睡眠呼吸暂停综合征(OSAS)是一种发病率较高的睡眠及呼吸障碍性疾病,可对全身多系统及器官产生损害.近年研究发现,OSAS可导致认知功能障碍,但其具体发病机制尚不明确,可能与慢性间歇低氧、睡眠结构紊乱等有关.认知功能障碍对OSAS患者的生活及工作产生了诸多不利影响.对OSAS伴发的认知功能障碍进行早期诊断及治疗对认知功能障碍的改善具有积极意义.

Head and neck squamous cell carcinoma (HNSCC) is a malignancy associated with more primary site,complicated pathological type,regional lymph node metastasis and recurrence.In recent years,along with gene chip,next generation sequencing,high-precision mass spectrometry and the coming of the era of big data,it is possible to apply the functional "omics"approaches for HNSCC in multiple level,which has become the important methods for exploring molecular mechanism of tumor occurrence and metastasis,developing early diagnosis and new targeted therapeutic molecular targets and assessing prognosis.In this review paper,we will investigate the application of "omics"approaches in the HNSCC and the series of hot issues studies based on"omics"approaches including exosomes,circulating tumor cells (CTCs) and circular RNA will also be discussed.

淋巴母细胞性淋巴瘤(lymphoblastic Lymphoma,LBL)是非霍奇金淋巴瘤的一种,其恶性度高,侵袭性强,患者大多预后不良.原发于鼻咽部的非霍奇金淋巴瘤因其症状隐匿,特异性不高,临床不易早期发现.多数研究表明,原发于鼻咽部的非霍奇金淋巴瘤以NK/T细胞性淋巴瘤为主[1],B细胞淋巴瘤较为少见,而B淋巴母细胞性淋巴瘤则更为罕见[2].本文报道1例原发于鼻咽部的B淋巴母细胞性淋巴瘤患者.