【摘要】 目的 探討老年人頭面部脈管肉瘤的臨床病理學特征。 方法 1996年-2008年對5例老年人頭面部脈管肉瘤的臨床資料、病理形態學、免疫組織化學染色進行觀察，并對其中4例進行了隨訪。 結果 臨床表現主要是頭面部發生的瘀斑、潰瘍或結節狀病變。腫瘤細胞圍繞皮膚附件周圍排列成交通狀吻合的血竇網，襯覆有異型性的內皮細胞，有的區域內皮細胞形成乳頭狀突起。腫瘤組織內有不同程度的彌漫性出血。腫瘤細胞表達CD34、CD31、Fli-1和FⅧ，部分表達CD117和CK8/18。經隨訪3例3年內死亡，1例帶瘤存活1年余，1例失訪。 結論 老年人頭面部脈管肉瘤組織形態多樣，預后較差，及時診治十分重要。需要與其他皮膚良性血管病變和低分化癌、惡性黑色素瘤、惡性梭形細胞腫瘤、Kaposi肉瘤等鑒別。【Abstract】 Objective To explore the clinicopathological features of cutaneous angiosarcoma on the scalp and face in elder patients. Methods The clinical data of five elder patients with cutaneous angiosarcoma on the scalp and face from 1996 to 2008 were retrospectively analyzed. The patients underwent the light microscopy, pathomorphological examination, and immunohistochemistry. Four patients were followed up. Results Most clinical manifestation was dusky irregular erythematous plaques which were often ulcerated. The tumor was composed of asymmetric collection of angulated and irregular vascular spaces infiltrating between collagen bundles. Endothelial cells attaching to the vascular spaces had hyperchromatic irregular nuclei and prominent nucleoli. Hemorrhage was another histologic feature. Positive expression of CD34,CD31,Fli-1 and FⅧ were found in tumor cells, and expression of CD117 and CK8/18 was found in some of the patients. In the follow-up duration, three patients died in three years, and one failed to be followed up. Conclusion Cutaneous angiosarcoma of the scalp and face has various histomorphology and poor prognosis, which should be diagnosed and treated in time. It should be distinguished from benign cutaneous hemangioma, poorly differentiated carcinoma, malignant melanoma and malignant spindle cell tumor.
摘要:目的:探討5·12汶川8.0級地震中顱面部外傷的影像學表現特點。方法: 回顧性分析自2008年5月12~31日因地震顱面部外傷在我院行CT、MRI檢查的傷員251例,其中CT檢查248例,MRI檢查16例。結果:放射檢查陽性162例,陽性率為64.54%,以40～49歲年齡組最多,為53例,其中男性41例。在放射檢查陽性中,多發傷112例(約69.13%),多類型顱面部外傷同時并存103例(約63.58%)。主要損傷發生率依次為軟組織損傷(35.50%),骨折(22.94%),腦挫裂傷(21.21%),硬膜下及硬膜外血腫(10.40%),其它(共約9.92%)。結論: 地震造成顱面部外傷人群主要為40～49歲中年男性,多發傷、多類型顱面部外傷多見,并以軟組織損傷、骨折、腦挫裂傷、硬膜下及硬膜外血腫較常見。Abstract: Objective: To describe the imaging features of head and face injured patients after the Wenchuan earthquake. Methods: The radiological information of 251 victims who were suspicious of head and face injury and underwent CT or MRI examinations from 12 May to 31 May 2008 was analysed retrospectively. There were 248 and 16 cases underwent CT or MRI examinations respectively. Results: One hundred and sixtytwo cases(64.54% )were positive. There were 53 cases in the 4049 years old age group, of which 41 were male. In patients with positive findings, 112 cases (about 63.58%) were comprised of several types of head and face injury. The incidence of the main injury type included: soft tissue injury (35.50%), fracture (22.94%), cerebral contusion (21.21%), subdural and epidural hematoma (12.40%), others (9.92%). Conclusions: The males with head and face injury in 4049 years old group were the major injured people in this earthquake. Head and face injury accompanied by multiple system injuries, the existence of several types of head and face injury at the same time were common. Among all the injury types, soft tissue injury, fracture, contusion, subdural and epidural hematoma were relatively commom.
目的探討頦下島狀皮瓣修復早期口腔鱗狀細胞癌術后缺損的療效。 方法2010年2月－2011年8月，收治15例早期口腔鱗狀細胞癌患者。男9例，女6例；年齡48～71歲，平均63歲。病程28～73 d，平均35 d。病變部位：舌3例，頰黏膜8例，磨牙后區2例，口底黏膜2例。根據2002版國際抗癌聯盟（UICC）口腔癌和口咽癌的TNM分期標準：T1N0M0 2例，T2N0M0 13例。病理分型：高分化鱗狀細胞癌11例，中等分化鱗狀細胞癌4例。病灶擴大切除后缺損范圍為5 cm × 3 cm～8 cm × 6 cm。1例因無明確回流靜脈改行游離前臂皮瓣修復，余14例均采用頦下島狀皮瓣修復，頦下島狀皮瓣切取范圍為6 cm × 4 cm～9 cm × 6 cm。 結果14例采用頦下島狀皮瓣修復患者手術時間為4 h 30 min～7 h 10 min，平均5 h 53 min。術后13例皮瓣順利成活；1例皮瓣發生表層壞死，經保守治療后成活。1例發生暫時性面神經下頜緣支麻痹，3個月后逐漸恢復；3例發生頜下積液，對癥治療后愈合。14例均獲隨訪，隨訪時間8～15個月，平均10.5個月。2例男性患者皮瓣上有毛發生長，3個月后逐漸稀少。患者面部外形、開口度及吞咽和語音功能均恢復良好；頦下供區瘢痕不明顯。1例行游離前臂皮瓣修復患者隨訪13個月，外形及功能恢復良好。隨訪期間無局部復發。 結論 頦下島狀皮瓣血供恒定，制備簡便、快捷，可用于修復早期口腔鱗狀細胞癌術后缺損。
