颈淋巴结转移癌与颈动脉的位置关系:CT分型及其临床意义

Relative location of cervical metastatic cancer and the carotid artery:CT types and the clinical application

目的:对颈部淋巴结转移癌与颈动脉的位置关系进行CT分型,并评价CT分型对术式选择的指导价值。方法:颈部转移癌患者230例。依肿瘤与颈动脉的关系将CT表现分为Ⅰ(分离)型,Ⅱ(切线)型,Ⅲ(包绕)型;Ⅲ型依包绕度分为4个亚型:Ⅲa型包绕0°～90°,Ⅲb型91°～180°,Ⅲc型181°～270°,Ⅲd型>270°。分析CT表现型与扪诊、术中所见、术式选择的关系。结果:Ⅰ型76例,肿瘤活动度良好,97.4%与动脉无接触。Ⅱ型105例,91.4%活动度良好,92.4%与动脉鞘接触但无黏连。Ⅰ、Ⅱ型的手术均不累及颈动脉。Ⅲ型49例,38.8%活动度差,61.2%完全固定,与动脉鞘接触但无黏连3例,黏连易剥离40例,该43例(87.8%)均作根治性颈清扫术;6例与动脉明显黏连无法剥离,其中3例作动脉外膜剥离,2例作动脉切除并重建,1例作姑息性切除。结论:CT表现型与扪诊和术中所见吻合度高,对术式选择具有重要指导意义。

PURPOSE： This study was designed to classify computed tomography （CT） manifestations of cervical metastatic cancer, and then evaluate the value of CT types for selection of surgical procedures. METHODS： Two hundred thirty patients with cervical metastatic cancer underwent surgical treatment and had CT scan preoperatively. According to the relationship between the tumor and the carotid artery（CA）,the manifestations shown on CT were classified into 3 types： type Ⅰ, tumors were apart from CA; type Ⅱ, tumors had tangent contact with CA; type Ⅲ, tumors encompassed CA. Type In was divided into 4 subtypes by the angles of embracement of CA： Ⅲa 0°-90°, Ⅲb 91°-180°, Ⅲc 181°-270°,Ⅲd〉 270°.CT types were compared with palpation, surgical finding, and operation patterns. RESULTS： Type Ⅰ involved 76 cases, all of the tumors were mobile, surgical finding showed 97.4% were apart from CA. 105 cases fell into type Ⅱ, 91.4% of the tumor were mobile. 92.4% of the tumors contacted CA sheath but without adherence. None of type Ⅰ and Type Ⅱ group underwent surgical procedure involving CA. 49 cases belonged to type m, 61.2% of the tumors were fixed. The tumors contacted CA sheath but without adherence in 3 cases, adhered to CA lightly but were peeled easily in 40 cases. These 43 cases （87.8%）underwent radical neck dissection. Six cases with the tumors adhered to CA wall firmly, 3 of them underwent peeling procedure, 2 underwent CA resection and construction. 1 underwent palliation because of extensive adherence. CONCLUSION： CT types had high coincidence with palpation and surgical finding, showing significant value for operation choice.