鼻咽结核与鼻咽癌并存的病例分析  

Patients with nasopharyngeal tuberculosis coexisting with nasopharyngeal carcinoma

作　　者：丘明生[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻喉科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2016年第6期379-381,共3页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：鼻咽结核(NPTB)与鼻咽癌(NPC)并存是罕见的病例。笔者曾诊治1例,结合梳理文献17例进行综述及讨论。NPTB与NPC并存的临床表现以颈淋巴结肿大(77.8%)最多见,其次是耳鸣(61.1%)和血涕(55.6%)。88.9%病变位于鼻咽顶后壁,其中83.3%显示结节状或隆起,22.2%表面呈糜烂、溃疡。临床漏诊、误诊率高达72.2%。笔者提出以下几点建议,希望有助于及时确诊此病:①临床思维需广阔,把NPTB与NPC并存纳入鼻咽疾病的鉴别诊断中;②认真分析临床症状,如遇颈淋巴结肿大,宜仔细区分淋巴结结核与NPC的不同特征;③善以应用影像学检查、衣壳抗原-免疫球蛋白A(VCA-IgA)测定、抗酸杆菌培养等对诊断有价值的检查方法;④病理组织检验结果现今仍为NPTB、NPC、NPTB与NPC并存三者确诊的金标准。活检必要时可重复三四次。NPTB与NPC并存的治疗有2种方案:①先用药物抗结核治疗2周,而后行放疗抗癌及药物抗结核治疗;②抗结核与抗癌同时、同步进行。这2种方案各有优缺点。Nasopbaryngeal tuberculosis （NPTB）coexisting with nasopharyngeal carcinoma （NPC）is a rare disease. The author reported one case combined with 17 cases in the literatures for review and discussion. The commonest clinical behavior was enlarged cervical lymph nodes（77.8% ）, followed by tinnitus （61.1%） and bloody nasal mucus （55.6%）. Eighty-eight point nine percent lesions were found presented on the roof-posterior wall, in which 83.3% presented as a tuber or swelling, and 22.2% showed surface erosion or ulcer. Seventy-two point two percent of NPTB coexisting with NPC were misdiagnosed. Suggestions were provided for the exact and timely diagnosis ： （1）Clinical thoughts must be broaden and NPTB coexisting with NPC should be included in the differential diagnosis of nasopharyngeal diseases; （2）To analyze the clinical features conscientiously, especially for the enlarged cervical lymph nodes patients, NPTB should be differed from NPC; （3）Exams including image scan （PET/CT, CT, MRI ）, VCA/IgA test, and mycobacterial culture should be used properly ; （4）Histopathologic exam result is the most important standard of diagnosis. It is necessary to make biopsy for several times. Two plans are suggested for the treatment： one is a 2-week anti-TB therapy, followed by anti-cancer and anti-TB therapy synchronization; the other is anti-cancer and anti-TB therapy at the same time. （ Chin J Ophthalmol and Otorhinolaryngol, 2016,16 ： 379-381 ）

关 键 词：鼻咽结核 鼻咽癌 并存 颈淋巴结肿大 鼻咽活检 

分 类 号：R739.63[医药卫生—肿瘤] R529.8[医药卫生—临床医学]