鼻咽结核及其合并鼻咽癌的诊治体会

Diagnosis of nasopharyngeal tuberculosis(NPTB) and NPTB with nasopharyng eal car cinoma

目的探讨鼻咽结核合并鼻咽癌的临床特征,提高认识,减少误诊.方法对自1984年3月～2004年1月,我们诊治的6例鼻咽结核合并鼻咽癌和20例鼻咽结核患者的临床资料进行分析.结果鼻咽结核组:①年轻;②颈淋巴结偏小、多个,多双侧,常融合成串,质地中,可活动;③耳、鼻症状少;④无颅神经损害;⑤EB病毒VCA-IgA抗体滴度测定阴性;⑥病变部位均在顶壁是其特点;⑦咽痛(12/20)和颈酸痛(13/20)可能又是鼻咽和颈淋巴结结核特有的临床症状.鼻咽结核合并鼻咽癌组:①中年居多;②颈淋巴结较大,质地硬,固定;③多有耳、鼻症状;④常伴颅神经损害;⑤EB病毒VCA-IgA抗体滴度测定阳性;⑥50%(3/6例)患者初诊误诊为鼻咽结核.结论鼻咽结核合并鼻咽癌易误诊,临床医师应提高警觉,与鼻咽结核的鉴别诊断除临床表现外,需做活检在病理上给予确诊,EB病毒VCA-IgA抗体滴度测定有重要的鉴别诊断价值.误诊会降低存活率.

Objective To investigate the clinical findings of na so pharyngeal tuberculosis(NPTB) and NPTB Complicated with nasopharyngeal carcinoma (NPC), to provide experience for the diagnosis and avoid the missing of NPC and misdiagnos is of NPTB. Methods 20 NPTB cases and 6 NPTB with NPC cases from 1984 to 2004 were analyzed. Results Clinic al manifestation of NPTB: ①Young. ②Cervical lymph: small, many, bilateral, so f t, movable.③With tuberculosis of lungs.④Unusual symptoms of the ear and the no se. ⑤No complications of cranial nerves. ⑥The roof plate of nasopharynx is a c ommon site.⑦Pharyngalgia and pain in the neck, the common joke. clinical mani fe station of NPTB with NPC: ①Older.②Cervical lymph: large, hard, fixation. ③H ea ring lose and tinnitus are common symptoms. ④Bloody-tinges discharge withdraw n from the nasopharynx. ⑤Usual involvement of the cranial nerves.⑥ The first missing rate of NPC being 50%(3/6). ⑦VCA/EA-IgA are positive mostly. Conclusion NPTB with NPC is easy to misdiagnosis. It could b e avoided by improved awareness of NPC and thorough analysis of clinical symptom s of the NPTB and NPTB with NPC. The repeated exact biopsy may be needed and th e diagnosis can be definite by pathological. VCA/EA-IgA is very important for th e diagnosis.