鼻咽癌邻近结构侵犯的CT诊断

CT Diagnosis of Nasopharyngeal Carcinoma with the Invaded Neighborhood Structure

目的探讨鼻咽癌原发部位及邻近结构侵犯的CT特点。方法收集经病理证实的鼻咽癌患者42例,通过临床和CT检查,分析鼻咽癌原发部位及邻近结构受侵的规律。结果本组42例,原发灶位于鼻咽侧壁29例(69.0%),顶后壁13例(31.0%),咽旁间隙受侵34例(81.0%),颈淋巴结转移31例(73.8%),颅底骨质破坏16例(38.1%)。其中,有咽旁间隙受侵的病例中,颈淋巴结转移达82.4%(28/34),明显高于咽旁间隙未受侵的病例37.5%(3/8)(P=0.02)。有颅底骨受侵者发生头痛和颅神经症状为87.5%(14/16),明显高于颅底骨未受侵的病例19.2%(5/26)(P<0.01)。结论鼻咽侧壁是鼻咽癌好发部位,颈部淋巴结转移与咽旁间隙受侵程度有关,头痛和颅神经症状阳性是颅底骨受侵的重要指征。

Objective To study the CT characteristics of nasopharyngeal cancer of original position and the invaded neighborhood structures.Methods 42 patients with nasopharynx cancer were confirmed by pathology.The rule of nasopharyngeal cancer of original position and the invaded neighborhood structures were retrospectively studied.Results In 42 patients,the original position of the nasophargngeal cancer was located in the lateral pharyngeal wall of 29 cases（69.0%）,the top posterior wall of 13 cases（31.0%）.And the parapharyngeal space was invaded in 34 cases（81.0%）.In the 34 cases of parapharyngeal space invasion,the lymph metastasis rate was 82.4%（28/34）,which was significantly higher than 37.5%（3/8） of the non-parapharyngeal space invasion（P=0.02）.And the positive symptom rate of headache and cranial nerve sign was 87.5%（14/16） in the patients with skull base invasion,which was higher than 19.2%（5/26） of the non-skull base invasion.Conclusion The lateral pharyngeal wall is the most common position that the nasopharyngeal cancer occurs,and the top posterior wall is the next.Cervical lymph node metastasis is related with the degree of parapharyngeal space involvement.Positive symptoms of headache and cranial nerve sign are important indications of skull base invasion.