眼耳鼻喉科鼻咽癌

1、鼻 咽 癌Nasopharyngeal Carcinoma(NPC)耳鼻咽喉-头颈外科 杨新明一、概述(outline)1、发病有一定的地区性(more common in south-east Asia in the world, more common in southern China) 我国头颈恶性肿瘤之冠(the top of the malignant tumor in head and neck)。某些高发区可能为全身恶性肿瘤之首，广东、广西、湖南和福建高发。2、高发年龄（maximum age incidence)：4060岁（86.62%）3、性别(sex)：男多于女(mal

2、e to female is 2:1)二、病因（etiology)(three possible causal factors)1、遗传因素(genetic factors)种族易感性家族聚集性(racial predilection, family tendency and HLA typing) 2、病毒因素-Epstein-Barr virus EB病毒NPC患者血清中检测到EB病毒相关抗体(patients with NPC have high level of antibody against EBV(over 90% of patients) ，NPC活组织的癌细胞中存在EBV D

3、NA特异性mRNA或基因表达产物(expression of gene products， (but whether the relationship between the two is causal or incidental is still unknown)3、环境因素(environment factors) 微量元素(microelement)：镍(nickel) 维生素缺乏(vitamin lack) 性激素失调(hormonal factors) 亚硝胺A combination of genetic, virus and environmental influences wo

4、uld best explain the occurrence of nasopharyngeal carcinoma)病理学(pathology)主要为低分化鳞癌。 少见腺癌、肉瘤等 Over 95% Squamous cell carcinoma( poorly differentiation)Adenocarcinoma, a, 好发部位most tumors arise on the posterosuperior wall or fossa of Rosenmuller 图 咽隐窝 鼻咽顶后壁临床表现(clinical manifestations)1、鼻部症状: 涕血或后吸涕带血，

5、鼻塞。nasal symptoms such as epistaxis, bloodypostnasal discharge, nasal obstruction2、耳部症状：分泌性中耳炎Secretory otitis media: conductivedeafness, fluid in the middle ear, tympanic membrane indrawn 3、颈淋巴结肿大（图）Metastases in the lymph nodes of the neck , regional nodal metastases are present in 60 to 80 per ce

6、nt of patients, with bilateral spread being evident in almost half. Superior deep jugular nodes are most often noted颈淋巴转移图4、颅神经症状:（图）involved cranial nerves: fifth and sixth nerve are the most frequently involved, Headache, internal strabismus. 4th , 3rd and 2nd cranial nerves are next most commonly

7、 affected. 9th, 10th 11th and 12th may also be involved 舌下神经麻痹 外展神经麻痹 Hypoglossal paralysis abducens paralysis 5、远处转移：Distant metastases occur to bone, lung, liver and other sites 诊断(Diagnosis)1、病史、症状和体征History, symptoms and signsEarly symptoms: bloody postnasal discharge fluid in the middle ear (un

8、ilateral)2、鼻咽镜检查The posterior rhinoscopyFibreoptic nasopharyngoscopy3、血清学检查EBVCA-IgA, EBVEA-IgG4、影象学检查Imaging CT, MRIPET-CTPET-CT原理PET是Positron Emission Tomography的缩写，译成中文则为：正电子发射型电子计算机断层。是利用正电子发射体标记的葡萄糖、氨基酸、胆碱、胸腺嘧啶、受体的配体及血流显像剂等药物为示踪剂，以解剖图象方式、从分子水平显示机体及病灶组织细胞的代谢、功能、血流、细胞增殖和受体分布状况，为临床提供更多的生理和病理方面的诊断信

9、息，因此，称之为分子显像或生物化学显像。PET的应用使核医学迈入分子核医学的新纪元。CT（Computer Tomography）计算机断层扫描 PET/CT中的CT通常采用单排至16排的螺旋CT。 PET/CT的工作原理是把PET和CT放在一起，通过PET扫描和CT扫描重边，联合扫描，使两者的硬件和软件有机地结合在一起。工作时，其CT球管发射X线，穿透人体组织，其探测器获得的数据不仅用于重建CT图像，同时提供给PET作为衰减校正的参数，在此基础上再进行PET图像的重建。所显示的图像为两者图像的融合的结果，即细胞的代谢显像和所处的解剖位置。 肿瘤诊断中的应用 例如，将示踪剂 18 F-FDG注

10、入人体代替脱氧葡萄糖，观察靶区葡萄糖代谢情况显示，根据恶性肿瘤的具有高代谢的特性诊断肿瘤的性质。尤其对于解剖部位复杂，密度对比不明显的部位，例如纵隔淋巴结是否有转移，能明确作出鉴别诊断，避免了漏诊，误诊 5、鼻咽活检确诊的方法Definitive diagnosis is made by biopsy鉴别诊断图鼻咽纤维血管瘤特点：常发生在10-25岁男必性反复大出血常易向周围结构侵犯堵塞鼻腔和鼻咽部引起系列症状诊断：1、病史，反复出血，年青男性；2、前后鼻镜，鼻内镜等检查，鼻腔和鼻咽部粉红色肿物，CT，MRI，DSA等影像学检查。NPC治疗(Treatment)放射治疗: Radiotherapy is the method of choice.