鼻咽癌颅底骨受累与相关症状的关系  

Relationship between Skull Base Infiltration and Correlational Symptom in Nasopharyngeal Carcinoma

作　　者：吴慧[1] 邱荣良[1] 张秀兰[1] 

机构地区：[1]河南省肿瘤医院放射治疗科,郑州市450008

出　　处：《医药论坛杂志》2005年第20期12-13,共2页Journal of Medical Forum

摘　　要：目的探讨鼻咽癌颅底骨受累与头痛和颅神经症状的关系.方法对经病理证实行首程放射治疗并做MRI检查的鼻咽癌患者58例,通过MRI检查结果分析鼻咽癌颅底骨受累与头痛和颅神经症状的关系,并推断其发生时间.结果鼻咽癌颅底骨受累的发生率为72.4%(42/58),破坏部位以斜坡最为常见,占81.0%(34/42),破坏的斜坡脑面出现硬膜强化增厚(硬膜尾征)占15.5%(9/58),4例放射治疗后3～12个月复查MRI,强化增厚的硬膜全部恢复正常或明显变薄.头痛发生率为56.9%(33/58),以颞、额部最为常见,占57.6%(19/33);颅神经症状阳性率为41.4%(2/58),以第V对最为常见,占83.3%(20/24).头痛、颅神经症状阳性及两者均出现的颅底骨受累发生率分别为97.0%(31/33),91.7%(22/24),95.0%(19/20).在颅底骨受累的病例中,头痛、颅神经阳性及两者均出现者分别占71.4%(30/42),50.0%(21/42),42.9%(18/42).上述两类症状出现2个月以上者颅底骨100.0%(23/23,8/8)受累,无症状的颅底骨受累发生率为50.0%(10/20).结论头痛和颅神经症状可能是鼻咽癌颅底骨受累的重要指征.Objective To establish the dependence of head ache and/or cranial nerve palsy （CNP） on skull base infiltration （ SBI ） in nasopharyngeal carcinoma（ NPC ）. Methods 58 patients with NPC received initial radiotherapy.All were diagnosed histologically and confirmed to have SBI by MRI. Analyses of the onset time and relationship between headache or CNP and SBI were performed.Results Incidence of SBI in NPC was 72.4% （The most common site of bone erosion was basilar elivus with a frequency of 81.0% （34/42）. 15.5% （9/58） manifested itseff as dural tail signs of cilvus infiltration on the side close to brain.In 4 of them, the involved dura mater was normalized or thinned obviously,as shown by MRI after radiotherapy （3 - 12 months）.The incidence of CNP was 56.9% （33/58）.Frontotemporal headache was most common in 57.6% （ 19 /33） ;The incidence of CNP was 41.4% （24/58）with the Ⅴ cranial nerve involved most commonly in 83.3 % （20/24）. Incidence of headache or CNP both in SBI were 94.0%（31/33） ,91.7% （22/24） ,95.0% （19/20） respectively. In the case of SBI ,the frequencies of headache CNP or both were 71.4% （30/42） ,50.0% （21/42） ,42.9% （ 18/42）,respectively. 100% （23/23,8/8） of patients with the afore mentioned symptom lasting over two months were demonstrated as having SBI, whereas asymptomatic SBI was found in 50.0% （10/20） patients.Conclusion Headache and cranial nerve palsy are considered as the major indicators of skull base infiltration in NPC.

关 键 词：鼻咽肿瘤 颅底骨侵袭 磁共振成像 

分 类 号：R739.63[医药卫生—肿瘤]