65例喉咽癌局部侵犯的CT扫描结果分析及其对治疗的指导意义  

Regional invasion of hypopharyngeal carcinoma base on CT—a report of 65 cases

作　　者：邓雪英[1,2] 苏勇[1,2] 郑列[1,3] 谢传淼[1,3] 尹韶涵[1,3] 

机构地区：[1]华南肿瘤学国家重点实验室,广东广州510060 [2]中山大学肿瘤防治中心放疗科,广东广州510060 [3]中山大学肿瘤防治中心影像介入中心,广东广州510060

出　　处：《癌症》2009年第6期647-651,共5页Chinese Journal of Cancer

摘　　要：背景与目的:了解掌握肿瘤局部浸润扩展的特性、准确判定肿瘤局部侵犯范围,是合理准确地定义和勾画肿瘤放射治疗靶体积的前提和关键。但目前喉咽癌相关的研究仍较少。本研究旨在通过对喉咽癌CT增强扫描结果的分析,探讨喉咽癌局部侵犯扩展的特性及其对治疗的指导意义。方法:回顾性分析2000年8月-2008年9月中山大学肿瘤防治中心收治的65例喉咽癌局部浸润侵犯的CT结果。结果:梨状窝癌(50例)容易侵犯杓会厌皱襞(98%)、喉咽后壁(80%)和同侧会厌(82%)、会厌前间隙(66%)、杓状软骨(74%)、声门旁间隙(82%)、室带(72%)、声带(62%)、甲状软骨板(58%)及口咽侧壁(52%)。咽后壁癌(14例)容易侵犯梨状窝(100%)、杓会厌皱襞(92.9%)、环后区(71.4%)、椎前筋膜(71.4%)及食管(64.3%)。1例环后区癌侵犯梨状窝、喉咽后壁、杓会厌皱襞、杓状软骨、声门旁间隙、环状软骨、甲状软骨及食管。结论:喉咽癌局部浸润扩散的途径和方式主要以直接蔓延侵犯为主,由近及远,与原发癌灶紧邻且局部缺乏组织屏障的组织器官更容易受到侵犯和破坏,未发现跳跃或跨越性侵犯。结果提示放射治疗时常规将鼻咽、颅底作为靶体积进行预防照射似无必要。Background and Objective： Identifying the characteristics of regional extension and accurately evaluating the extent of regional invasion is the key to delineate the target volume of hypopharyngeal carcinoma. This study was to investigate the characteristics of regional invasion of hypopharyngeal carcinoma using the enhanced computed tomography （CT） scan. Methods. CT images of 65 patients with hypopharyngeal carcinoma treated at Sun Yat-sen University Cancer Center between August 2000 and September 2008 were retrospectively analyzed. The patients included 58 males and two females, with a median age of 55 years. Results. Pyriform sinus carcinoma （50 cases）easily extended to aryepiglottic fold （98%）, posterior hypopharyngeat wall （80%） and ipsilateral epiglottis （82%）, preepiglottic space （66%）, arytenoid cartilage （74%）, paraglotic space （82%）, ventricular bands （72%）, vocal （62%）, laminae of thyroid cartilage （58%） and lateral wall of oropharynx （52%）. Posterior pharyngeal carcinoma （14 cases） usually invaded pyriform sinus （100%）, aryepiglottic fold （92.9%）, postcricoid region （71.4%）, prevertebral fascia （71.4%） and esophagus （64.3%）. One case of postcricoid carcinoma spread to pyriform sinus, posterior wall of hypopharynx, aryepiglottic fold, aryepiglottic cartilage, paraglotic space, cricoid cartilage thyroid cartilage and esophagus. Conclusion： Regional invasion of hypopharyngeal carcinoma is mainly direct extension through tissues. Tissues close to the primary tumor site and lack of regional tissue barrier are easier to be encroached and destroyed. The skip lesion is not detected. Routine prophylactic irradiation of nasopharynx and base of skull is not necessary.

关 键 词：喉咽肿瘤 局部侵犯 CT扫描 影像特征 诊断 放射治疗 靶体积 

分 类 号：R739.6[医药卫生—肿瘤]