下咽癌局部侵犯的影像学表现及意义

Imaging Findings of Hypopharyngeal Carcinoma Local Invasion

目的分析下咽癌局部侵犯的影像学表现规律并探讨其临床意义。方法回顾性分析我院2006年7月～2009年7月收治的68例下咽癌CT/MRI检查结果。结果梨状窝癌占79.4%,咽后区癌占17.5%,环后区癌占2.9%。梨状窝癌最易侵犯杓会厌皱襞(90.7%)、杓状软骨(83.3%)、喉旁间隙(81.5%)、咽后壁(77.8%)、甲状软骨(70.4%)、会厌前间隙(70.4%),其他较易侵犯的部位有会厌、假声带、声带、环后区及口咽;咽后壁癌易侵犯杓会厌皱襞(100%)、梨状窝(100%)、椎前筋膜(66.7%),颈段食管(66.7%)、杓状软骨(75%)、环状软骨(50%)及口咽(41.7%);环后区癌易侵犯颈段食管、椎前筋膜、梨状窝、环状软骨、咽后壁、杓会厌皱襞、杓状软骨、喉旁间隙、甲状软骨。结论下咽癌以直接侵犯为主,较少侵犯到鼻咽及颅底,放射野包含鼻咽及颅底可能未必需要。

Objective To analyze the imaging features of hypopharyngeal carcinoma by using CT/MRI and explore their clinical significance. Methods A retrospective analysis was made of CT/MRI examination results of 68 cases of hypopharyngeal carcinoma in our hospital from July 2006 to July 2009. Results Of the 68 cases,54 cases（79.4%）were pyriform sinus carcinoma, 12（17.5%） were posterior pharyngeal carcinoma and 2（2.9%） were postcricoid carcinoma. Pyriform sinus cancer most likely invaded the aryepiglottic fold （90.7%）,then the arytenoid cartilage（83.3%）,paraglotic space（S1.5%）,posterior wall（77.8%）,thyroid cartilage（70.4%） and preepiglottic space（70.4%）, and other more easily invaded parts were the epiglottis, false vocal cords, vocal cords, central, postcricoid area and oropharynx. Posterior pharyngeal carcinoma involved aryepiglottic fold （100%）,prevertebral fascia （100%）,prevertebral fascia （66.7%）, esophagus （66.7%）, arytenoid cartilage （75%）, cricoid cartilage （50%）, and oropharynx （41.7%）. postcricoid carcinoma usually involved esophagus, prevertebral fascia,prevertebral fascia, cricoid cartilage, posterior wall, aryepiglottic fold, arytenoid cartilage, paraglotic space and thyroid cartilage. Conclusion Hypopharyngeal carcinoma shows a direct invasion through tissues. Nasopharynx and base of skull were not invaded usually. The target of radiotherapy including nasopharynx and base of skull will not be necessary.