鼻咽粘液表皮样癌——附8例临床分析

Nasopharyngeal mucoepidermoid carcinoma:A report of eight cases

目的 探讨分析鼻咽粘液表皮样癌的临床诊治及预后。本文对我院治疗过的鼻咽粘液表皮样癌病例进行综合分析。方法 回顾分析1996年12月-2006年2月收治的8例鼻咽粘液表皮样癌患者。从发病到确诊最短为2．0个月，最长为36．5个月，平均为10．4个月。确诊前5例误诊。鼻咽肿瘤以位于鼻咽侧壁、顶后壁为主，局部多侵犯鼻腔、颅底、咽旁、头长肌。颈部淋巴结转移少见，仅1例。3例采用单一治疗（1例放疗、2例手术），5例综合治疗（2例术前放疗、3例术后放疗）。结果 ①近期疗效：治疗结束后3个月，6例达CR其中（5例采取综合治疗），1例达PR（单纯切除＋放疗），1例SD（单独放疗）；②远期疗效：随访4．2—90．9个月，中位随访期26．9个月，8例患者均存活，其中6例无瘤存活，2例原位带瘤生存。自随访以来，无一例有颈部淋巴结及远处转移。结论 鼻咽粘液表皮样癌进展慢，疾病误诊率高，临床表现以局部症状为主，颈部淋巴结和远处转移少见，治疗上应以手术为主辅以放疗。

Objective To study the clinical diagnosis, treatment outcomes and prognosis of the patients with nasopharyngeal mucoepidermoid carcinoma. Methods Pertinent medical records were reviewed from 8 patients with nasopharyngeal mucoepidermoid carcinoma （MEC）. There was a significant delay from the onset of symptoms to the time of diagnosis with a range of 2. 0 to 36.5 months and a mean time of 19.3 months. 5 patients were misdiagnosed before definite diagnosis. The lateral and roof- posterior wall was the most common sites of origin of nasopharyngeal MEC which invaded mainly the nasal cavity, the base of the skull, the parapharyngeal space and the longus capitus. Metastasis to the cervical lymph nodes was uncommon. Unitary therapy in 3 patients （ RT 1, S 2）, multimodality therapy in 5 patients （ R ＋ S 2,S ＋ R 3）. Results ①Short - term effect ： To recheck at 3 months after treatment, 6 with CR （5 with comprehensive treatment）, 1 with PR （simple resection plus RT）, 1 with SD （Unitary RT）. ②Long - term effect- After a median follow - up of 26. 9 months （ range from 4. 2 to 90. 9 months）, 8 patients are surviving （6 without disease, 2 with primary residual, nobody with cervical lymphatic spread and distant metastasis）. Conclusion Nasopharyngeal MEC has long course, high misdiagnose rate, locally clinical manifestation, uncommon cervical lymphatic and distant metastasis. Primary surgery followed RT was recommended.