彩色多普勒超声与触诊对鼻咽癌N分期结果的比较  

Comparison between color Doppler ultrasonography and palpation in N-staging of nasopharyngeal carcinoma

作　　者：徐晓红[1] 廖思海[2] 刘锋[1] 杨志雄[2] 温赐祥[1] 廖桂英[1] 

机构地区：[1]广东医学院附属医院超声科,湛江524001 [2]广东医学院附属医院放射治疗科,湛江524001

出　　处：《中华超声影像学杂志》2005年第9期691-694,共4页Chinese Journal of Ultrasonography

基　　金：广东省卫生厅医学科研基金立项课题(B2002093)

摘　　要：目的探讨彩色多普勒超声与触诊对鼻咽癌N分期诊断结果的差异性。方法对163例病理确诊的初诊鼻咽癌患者行颈部彩色多普勒血流显像(CDFI)检查,测量指标为受检淋巴结的纵径、横径比值(L/T)及其血流参数,并选择部分受检淋巴结在超声定位下行穿刺活检。结果CDFI联合细胞穿刺检查使常规临床分期发生了较大的变化,66例N0患者有29例(43.94%)升级为N1;47例N1患者有5例(10.64%)降级为N0;44例N2患者有8例(18.18%)降级为N1;69例单侧淋巴结转移患者有18例(26.09%)为双侧转移。临床触诊的淋巴结大小较CDFI检查大(P<0.001)。L/T值、收缩期血流速度、舒张末期血流速度和阻力指数(RI)在良、恶性淋巴结之间的差异有显著性意义(P<0.001)。以L/T<2.0和RI>0.6分别作为诊断恶性淋巴结的标准时,二者的准确率、敏感性和特异性分别为86.9%、81.5%,90.4%、88.8%和77.5%、74.6%,均高于以淋巴结横径>7.0mm为标准时的诊断效率。结论CDFI联合细胞穿刺检查比临床触诊能更准确地判断转移淋巴结,从而为鼻咽癌的临床N分期提供可靠依据,使预后及放射治疗计划发生改变。Objective To study the difference between color Doppler flow imaging （CDFI） and palpation in N-staging of nasopharyngeal carcinoma （NPC）. Methods CDFI was used to detect longitudinal/transverse diameters （L/T） and bloodstream parameters of the metastatic nodes in 163 firstvisiting patients with pathologically diagnosed NPC, and aspiration biopsy was performed on some of them by ultrasound localization. Results CDFI plus aspiration biopsy made the conventional N-staging results changed： 43.94%（29/66） from N0 to N1; 10.64%（5/47） and 18.18% （8/44） from N1 and N2 to N0 and N1, respectively; and 26.09%（18/69） from unilateral to bilateral nodal metastasis. The sizes of lymph nodes were larger by palpation than those by CDFI（ P〈0. 001）. There were significant differences in L/T ratio, peak systolic velocity, end diastolic velocity and resistant index（RI） between benign and malignant lymph nodes（ P〈0. 001）. L/T ratio 〈2.0 and RI〉 0.6 as the diagnostic standard for metastatic node, their diagnosis sensitivity and specificity rates were 86.9% and 81.5%, 90. 4% and 88.8%, 77.5% and 74.6%, respectively, whose diagnostic efficiencies were superior to those by transverse diameter 〉7.0 mm being the diagnostic standard. Conclusions Combined application of CDFI with needle biopsy is more suitable in the judgement of nodal metastasis compared with the clinical palpation, which provides more reliable evidence of N-staging of NPC and thus improves the patients＇ radiotherapy treatment planning and prognosis.

关 键 词：彩色多普勒超声 触诊 鼻咽癌 肿瘤N分期 细胞穿刺检查 放射治疗 

分 类 号：R739.63[医药卫生—肿瘤] R730.4[医药卫生—临床医学]