多层螺旋CT在下咽癌诊断及手术中的应用

The application of multi-slice computed tomograph in diagnosis and operation of hypopharyngeal carcinoma

目的:探讨多层螺旋CT(MSCT)在下咽癌的诊断及手术中的应用价值,为耳鼻咽喉科医生手术提供理论依据。方法:回顾性分析45例经手术和病理证实下咽癌患者的MSCT和手术资料,所有MSCT扫描均采用增强扫描,扫描范围从硬腭至颈段食管。结果:45例下咽癌中位于梨状窝癌34例,环后区癌7例,下咽后壁癌4例。MSCT增强扫描显示下咽软组织影呈轻度或明显强化,梨状窝变窄或消失,咽后壁软组织增厚,喉软骨破坏、移位及侵犯食管入口、颈段食管和颈淋巴结转移。肿瘤可推移环状、杓状软骨向前移位及甲杓间隙和环甲关节间距增宽。根据MSCT制定的手术计划与实际基本一致,达91.1%。结论:MSCT能很好地显示下咽癌的部位、大小和侵犯范围及有无淋巴结转移,对制定手术计划具有指导意义。

Objective：To evaluate the clinical application of multi slice CT（MSCT） in hypopharyngeal carcinoma and serve otolaryngologist to institute proper operation. Method：Forty-five patients with hypopharyngeal carcinoma scanned by MSCT were studied and confirmed by operation and pathologic examination. The operation material were retrospectively analyzed. All the cases were used for the enhancement scanning, whose scope was from hard palate to cervical segments of esophagus. Result.. Of 45 cases,34 cases derived from piriform fossa,7 cases were from the postcricoid region and 4 cases were in the posterior wall of hypopharynx. The tumor showed isodense or mixed density and slightly enhancement, piriform fossa became narrow or disappeared, retropharyngeal soft tissue thickened, laryngeal cartilage and esophageal ostium were invaded and lymph nodes of neck became metastasis. The tumor pushed the annular and arytenoids cartilage displacement anteriorly; the thyroid arytenoidal gap and cricothyroid joint were widened. The operation plan that was made according as MSCT was almost agreed with actual operation, The consistent rate is 91.1% （41/45）. Conclusion：MSCT examination can accurately diagnose and exhibit the extension of the tumors and detect metastasis to lymph nodes, and provide reliable basis for surgery therapy.