下咽癌颈部及咽后淋巴结转移的CT/MRI分析

Analysis of cervical and retropharyngeal lymph node metastases in the patients with hypopharyngeal carcinoma with computed tomography and magnetic resonance imaging

背景与目的:下咽癌早期即可出现区域淋巴结转移,然而关于下咽癌区域淋巴结尤其是咽后淋巴结转移的报道少见。本研究旨在通过对下咽癌CT/MRI扫描结果的分析,探讨下咽癌区域淋巴结特别是咽后淋巴结转移的特性,为临床治疗提供参考。方法:回顾性分析2000年8月至2009年3月我院病理证实的88例下咽癌区域淋巴结转移的CT/MRI结果。对其局部分期、各区域淋巴结转移的相互关系采用χ2检验和Logistic多因素分析研究。结果:下咽癌的区域淋巴结转移率为73.9%,Ⅱa、Ⅱb、Ⅲ区淋巴结转移发生率最高,分别为61.4%、44.3%及37.5%。Ⅰ、Ⅳ、Ⅴ、Ⅵ区及咽后淋巴结转移都较少,并且均合并Ⅱ、Ⅲ区淋巴结转移。单因素分析显示Ⅰb、Ⅲ区淋巴结转移与Ⅳ区淋巴结转移,Ⅱb区、双侧颈部淋巴结转移与咽后淋巴结转移的关系有统计学意义。多因素分析结果显示Ⅳ区淋巴结转移与Ⅵ区淋巴结转移,双侧颈部淋巴结转移与咽后淋巴结转移的关系有统计学意义。结论:下咽癌区域淋巴结转移途径遵循一定的规律,跳跃性转移少见,以Ⅱ、Ⅲ区转移最常见。双侧颈部淋巴结可能是咽后淋巴结转移的危险因素。

Background and Objective： Hypopharyngeal carcinoma has a high risk for early regional lymphatic dissemination. However, reports about regional lymph node metastases, especially retropharyngeal lymph node metastases, are rare. This research explored the spread of hypopharyngeal carcinoma, especially metastases of the retropharyngeal lymph nodes by studying computed tomography （CT） and magnetic resonance imaging （MRI） images. Methods： The CT/MRI images of 88 patients with pathologically confirmed hypopharyngeal carcinomas that were performed at our hospital between August 2000 and March 2009 were analyzed retrospectively. The interrelations among local stage and lymph nodes in various regions were analyzed by X2 test and multivariate logistical regression. Results： The rate of regional lymph node metastasis for all patients was 73.9%, and the highest rates of positive lymph nodes were at levels II a （61.4%）, II b （44.3%）, and III （37.5%）. Metastases to levels I , IV, V, and Vl were rare, as were retropharyngeal lymph-node metastases, which were always combined with metastases at levels II and III. Univariate analysis showed that level-IV metastases correlated to metastases at levels I b and III ; retropharyngeal lymph node metastases were correlated to level II b and bilateral cervical lymph node metastases. Multivariate analysis showed that level-Vl metastases correlated to level IV and that retropharyngeal lymph-node metastases correlated to bilateral cervical lymph node metastases. Conclusions. Regional lymph node metastases in patients with hypopharyngeal carcinoma follow some regulations, and skip metastasis is rare. The highest rates of positive lymph nodes are at levels II and III. Bilateral lymph node metastases may be a risk factor for retropharyngeat lymph node metastases.