鼻咽癌颈 部淋巴结转移与咽旁间隙受侵的关系

作者对本院1985年12月至1988年8月首次治疗前的196例鼻咽癌临床及CT扫描发现的资料进行了分析。单侧或双侧颈部淋巴结转移灶≥3cm者,咽旁间隙及颈动脉鞘受侵率分别为65.42％(70/017)及62.62％(67/017),但颈部淋巴结转移灶<3cm者,咽旁间隙及颈动脉鞘受侵率仅为15.63％(5/32)及12.5％(4/32),二者具有显著性差异(P<0.005);咽旁间隙及颈动脉鞘受侵者,颈部淋巴结转移率分别为84.27％(75/89)及84.52％(71/84)。4例后组颅神经受累者全部有咽旁间隙受累,其它颅神经受累者咽旁间隙受侵者仅为35.71％(10/28)。我们的资料表明,颈部淋巴结转移灶与颈动脉鞘关系密切,颈部淋巴结转移可能是原发灶直接侵犯颈动脉鞘后产生的。在缺少CT扫描的情况下,根据颈部淋巴结大小,我们提出鼻咽癌放疗设野的建议。

THE RELATIONSHIP BETWEEN THE METASTATIC NECK LYMPH NODE OF NASOPHARYNGEAL CARCINOMA AND INVOLVEMENT OF THE PARANASOPHARYNGEAL SPACES

From December 1985 to August 1988, a total of 196 patients with nosopharyngeal carcinoma who received CT scan before initial treatment in our hospital was analysed. Among 107 patients had unilateral or bilateral neck node of diameter larger than 3cm, the incidence of involvemet in the parapharyngeal spaces was 65.4% (70 / 107) and in carotid sheath area was 62.62% (67/107), while for the 32 patients with metastatie lymph node less than 3cm, the incidence of involvement in the paraparyngeal spaces was 15.63%(5/32) and in carotid sheath area was only 12.5%( 4 /32),respectively The difference was highly significant statistically (P<0.005). 84.27%(75/89) patients with the parapharyngeal spaces involvement and 84.52% ( 71/84) patients with carotid sheath area involvement had metastatie neck lymph node.All four patients with paralysis of the last four crahial nerves had involvement of the parapharyngeal spaces. While among p-atients with other oranial nerves involved , the incidence of involvement of the parapharyngeal spaces was only 35.71% (10/28) . Our results indicated that theree was closely relatbnship between the metastatie neck lymph nodes of NPC and the involement of the perapharyngeal spaces. The metastatie neck node of NPC may be probably caused by direct infiltration of tumor via the carotid sheath area. For the patients with noct examina tion the radiation field was designed mainly accorded to the size of the metastatie neck lymph node.