鼻咽癌颅底转移特点的临床研究

Characteristics of skull base metastasis of nasopharyngeal carcinoma

目的探讨鼻咽癌颅底侵犯和转移的发生规律、途径及其临床意义。方法回顾性分析101例经病理确诊并经MRI检查发现有颅底侵犯的鼻咽癌病人的MRI资料,对鼻咽癌颅底侵犯方式、发生率及侵犯和转移的解剖部位进行研究。结果本组发生颅底直接侵犯84例(83.2%),颅底转移17例(16.8%)。颅底直接侵犯最易受累的部位依次为蝶窦和鞍底、海绵窦、斜坡、颈内动脉管。颅底转移多发生在颈内动脉管和颈静脉孔区域。结论鼻咽癌早期存在颅底淋巴结转移,通过鼻咽癌颅底侵犯和转移的MRI研究,提高鼻咽癌颅底侵犯影像学诊断的准确性,选择合适的靶区和放疗技术,选择恰当的手术入路,以达到提高鼻咽癌病人的生存率,改善其生存质量的目标。

Objective To explore developing patterns, pathway and clinical significance of invasion and metastasis of nasopharyngeal carcinoma （NPC） in the skull base. Methods MRI data of 101 NPC patients with invasion in skull base determined by pathological and MRI findings were analyzed retrospectively. The invasion pattern, incidence and anatomic sites of invasion and metastasis of NPC were studied. Results The skull base invasion occurred in 84 patients （83.2%） and skull base metastasis in 17 （16.8%）. The most easily affected sites in direct skull base invasion were ordered as sphenoid sinus and sella base 〉 cavernous sinus 〉 clivus 〉 internal carotid canal. The skull base metastasis occurred predominantly at the internal carotid canal and jugular foramen area. Conclusion Due to the presence of early lymphatic metastasis of NPC in the skull base, MRI examination for skull base invasion and metastasis of NPC can be helpful to increase the accuracy of imaging diagnosis and select appropriate target sites, radiotherapy technique and surgical approach for increasing survival rate of NPC patients and improving their quality of life.