牙龈癌的MSCT诊断及外科治疗

MSCT diagnosis and surgical treatment of gingival carcinoma

目的 分析牙龈癌的MSCT表现特征及诊断价值,评价CT检查在牙龈癌诊断中的应用价值。方法 回顾性分析经手术及病理证实的牙龈癌18例,其中男12例,女6例,年龄55~87岁,平均年龄68岁。18例均行CT平扫及增强CT扫描。对病变的部位、形状、密度及向周围浸润转移情况等几个方面进行回顾性分析。结果 18例病理类型均为鳞状细胞癌,下颌骨前牙区8例,下颌骨磨牙区4例,上颌骨前牙区5例,上颌骨磨牙区1例,18例均伴有颌骨溶骨性骨质破坏,15例伴有溃疡,侵犯颊部软组织1例,侵犯上颌窦1例,侵犯口底2例,同时侵犯腭部及上颌窦1例,7例伴有颌下及颈部淋巴结多发转移。牙龈癌CT平扫表现为上下颌骨牙龈区等或稍低密度不规则肿块,边界均模糊不清,内密度不均匀,浸润性生长。CT增强扫描后肿块明显不均匀强化,坏死囊变区不强化,增强后肿块边界及轮廓显示清楚,呈分叶状,7例颌下区及颈部间隙内可见多发大小不等的肿大淋巴结,增强后明显不均匀强化。结论 CT检查对原发性牙龈癌的形态、大小、密度及周围结构侵犯以及颈部淋巴结转移等方面有重要的诊断价值,增强扫描对病灶显示尤为重要。

Objective To analyze the multislice spiral CT features of gingival cancer and evaluate the application value of CT examination for the diagnosis of gingival carcinoma. Methods A retrospective analysis was proceeded in 18 cases of gingival cancer that confirmed by surgery and pathology, including 12 male and 6 female cases, aged from 55 to 87 years, mean age was 68 years. 18 cases underwent CT plane scan and contrast enhancement scan. The site, shape and density of the lesions, the surrounding involvement and metastasis were analyzed retrospectively. Results Pathological types of all cases were squamous cell carcinoma. Locations of the lesions were 8 cases at mandibular Anterior overbites region, 4 cases at mandibular molar region, 5 cases at maxillary anterior region and one case at maxillary molar region respectively. 18 cases were associated with osteolytic bone destruction of the mandibular and 15 cases with ulcers. One case involved buccal, one case involved the maxillary sinus, 2 cases involved the oral cavity, both of the oral cavity and the maxillary sinus was involved in one case, in seven cases, of multiple submandibular and cervical lymph nodes metastases were detected. The signs of the gingival carcinoma in CT plane scan were ill defined irregular mass with iso-density or slightly low-density at the areas of maxillary and jaw. The lesions growed invasively. Contrast enhancement scan showed markedly heterogeneous enhancement, necrotic or cystic areas were not enhanced, and the lobulated margin of the mass was displayed clearly. In seven cases, multiple lymph nodes in variable size were detected at submandibular and neck region, and significantly heterogeneously enhanced. Conclusion CT examination has significant value for diagnosis of the site, shape, size, density, surrounding involvement and cervical lymph node metastasis of the primary gingival carcinoma and, enhancement scan is particularly important for displaying the lesion.