儿童及青少年鼻咽部病变的临床分析  

Clinical case analysis of nasopharyngeal lesions in children and adolescents

作　　者：陆兆屹 史雅文[1] 汪李琴 殷敏[1] 程雷[1] 崔昕燕[1] LU Zhaoyi;SHI Yawen;WANG Liqin;YIN Min;CHENG Lei;CUI Xinyan(Department of Otorhinolaryngology,the First Affiliated Hospital,Nanjing Medical University,Jiangsu Province Hospital,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院,江苏省人民医院耳鼻咽喉科,江苏南京210029

出　　处：《中国耳鼻咽喉颅底外科杂志》2025年第1期64-68,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：江苏省自然科学基金青年项目(BK20230739)。

摘　　要：目的分析儿童及青少年鼻咽部恶性肿瘤的病理学特点、临床表现、诊治过程及误诊情况,探讨诊疗中值得关注的问题。方法回顾南京医科大学第一附属医院(江苏省人民医院)2015年1月—2022年12月诊治的1480例儿童及青少年鼻咽部病变患者,其中恶性肿瘤20例,分析鼻咽恶性肿瘤患者的临床表现、病理学类型及诊疗过程等,探讨诊断过程存在的问题和疏漏。结果鼻咽部恶性肿瘤包括鳞状细胞癌16例,淋巴瘤2例,乳头状腺癌1例,脊索瘤1例。恶性肿瘤病例的初期临床症状以鼻部为主7例,其中4例被误诊为腺样体肥大;以耳部为主5例,其中2例被误诊为单纯分泌性中耳炎;以颈部为主8例,未见误诊。总误诊率达30%(6/30)。误诊患者的确诊前病程长于非误诊患者,差异具有统计学意义(Z=-3.160,P<0.01)。以颈部症状为主的患者确诊前病程短于以鼻部症状为主的患者(Z=-2.078,P<0.05)和以耳部症状为主的患者(Z=-2.372,P<0.05)。结论多种鼻咽恶性肿瘤可能发生在儿童及青少年人群且通常无特异性临床表现,其中以鼻部和耳部症状为主的患者尤其容易被误诊,临床上应注意鉴别。Objective To analyze the pathological features,clinical manifestations,diagnosis and treatment process as well as misdiagnosis of nasopharyngeal malignant tumors in children and adolescents,and to discuss the problems worth attention in the diagnosis and treatment.Methods A retrospective analysis was conducted on 1480 cases of nasopharyngeal lesions in children and adolescents diagnosed and treated in the first affiliated hospital of Nanjing medical university(Jiangsu provincial people’s hospital)from January 2015 to December 2022.Among them,20 patients suffered from malignant tumors,their clinical manifestations,pathological types and diagnosis and treatment were analyzed,the problems and omissions in the diagnosis were discussed.Results The nasopharyngeal malignant tumors included 16 cases of squamous cell carcinoma,2 cases of lymphoma,1 case of papillary adenocarcinoma and 1 case of chordoma.Four of 7 cases with initial nasal symptoms were misdiagnosed as adenoid hypertrophy,2 of 5 cases with initial otologic symptoms were misdiagnosed as simple secretory otitis media,and none of 8 cases with initial neck symptoms was misdiagnosed.The total misdiagnosis rate was 30%(6/30).The disease course of misdiagnosed patients was longer than that of non-misdiagnosed patients,and the difference was statistically significant(Z=-3.160,P<0.01).The duration of the disease before diagnosis in the patients with neck symptoms was shorter than that in the patients with mainly nasal symptoms(Z=-2.078,P<0.05)or with mainly otologic symptoms(Z=-2.372,P<0.05).Conclusion Several nasopharyngeal malignancies may occur in children and adolescents,and usually have no specific clinical manifestations,among which patients with only nasal and/or otologic symptoms are especially easy to be misdiagnosed,and should be distinguished clinically.

关 键 词：鼻咽部病变 恶性肿瘤 儿童及青少年 误诊 

分 类 号：R766.3[医药卫生—耳鼻咽喉科]