鼻窦冠状位CT在诊断和治疗鼻腔鼻窦恶性肿瘤中的价值

The value of coronal CT in the management of sinonasal malignancies

目的:探讨鼻窦冠状位CT在诊断和治疗鼻腔鼻窦恶性肿瘤中的价值。方法:回顾分析50例鼻腔鼻窦恶性肿瘤冠状位CT表现,根据鼻窦冠状位CT上显示的肿瘤侵犯范围制订治疗方案。结果:所有鼻腔鼻窦肿瘤均经鼻内镜下取病理确诊,其中鼻腔鼻窦鳞癌占30.0%(15/50),黑色素瘤占14.0%(7/50),腺样囊性癌占14.0%(7/50),嗅神经母细胞瘤占8.0%(4/50),淋巴瘤占14.0%(7/50),其他恶性肿瘤占20.0%(10/50)。鳞癌多侵犯上颌窦,占66.7%,鼻腔鼻窦黑色素瘤多发于鼻腔,侵犯筛窦达71.4%,嗅母细胞瘤多起源于鼻腔,侵犯筛窦达100.0%,鼻腔鼻窦淋巴瘤侵犯鼻腔双侧达28.6%,在各鼻窦均可有发生和侵犯。根据鼻窦冠状位CT病变范围选择术式,鼻内镜下切除肿瘤为30.0%(15/50)、鼻内镜下仅取病理为26.0%(13/50)、鼻内镜辅助经上颌窦手术为14.0%(7/50)、鼻内镜辅助鼻侧切20.0%(10/50)、上颌骨和或眶内容物手术分别为10.0%(5/50)。结论:鼻窦冠状位CT能清楚显示病变范围和累及部位,对于鼻腔鼻窦恶性肿瘤的诊断和选择治疗方案具有重要价值。

Objective：To explore the value of CT findings in the diagnosis and management of sinonasal malignancies.Methods：Fifty cases of coronal CT findings in sino-nasal malignancies were analysed retrospectively,and treatment planning were made depending on the CT manifestations.Results：All of the tumors were diagnosed under endoscopy.The rates of squamous cell carcinoma,melanoma,adenoid cystic carcinoma,olfactory neuroblastoma,lymphoma,and other malignancies were 30.0%（15/50）,14.0%（7/50）,14.0%（7/50）,8.0%（4/50）,14.0%（7/50） and 20.0%（10/50）,respectively in which 66.7% of the squamous cell carcinomas invaded maxillary sinus;Most of the melanoma originated from nasal cavity,71.4% of which invaded ethmoid sinus;Most of the olfactory neuroblastoma originated from nasal cavity,100.0% of which invaded ethmoid sinus;28.6% of the lymphoma invaded both nasal cavities,also can occur in each of the sinuses.To select treatment method based on coronal CT findings：30.0%（15/50） of the tumors were removed under endoscopy;26.0%（13/50） of the patients were treated with chemotherapy or radiotherapy after diagnosed under endoscopy;14.0%（7/50） of the tumors were removed with Caldwell-Luc operation combined with endoscopy;20.0%（10/50） of the tumors were removed through nasal lateral approach combined with endoscopy;10.0%（5/50） of the tumors needed to remove the partial or complete maxillary bone.Conclusion：The lesions and invasions of sino-nasal malignancies could be shown clearly on coronary CT of the nasal sinus,which has great value in the diagnosis and treatment selection of sino-nasal malignancies.