耳鼻咽喉頭頸外科學(xué)：鼻咽癌

1、鼻 咽 癌Nasopharyngeal Carcinoma(NPC)一、概述(outline)1、發(fā)病有一定的地區(qū)性(more common in south-east Asia in the world, more common in southern China) 我國頭頸惡性腫瘤之冠(the top of the malignant tumor in head and neck)。某些高發(fā)區(qū)可能為全身惡性腫瘤之首，廣東、廣西、湖南和福建高發(fā)。2、高發(fā)年齡（maximum age incidence)：4060歲（86.62%）3、性別(sex)：男多于女(male to female i

2、s 2:1)二、病因（etiology)(three possible causal factors)1、遺傳因素(genetic factors)種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患者血清中檢測(cè)到EB病毒相關(guān)抗體(patients with NPC have high level of antibody against EBV(over 90% of patients) ，NPC活組織的癌細(xì)胞中存在EBV DNA特異性mRNA或基因表

3、達(dá)產(chǎn)物(expression of gene products， (but whether the relationship between the two is causal or incidental is still unknown)3、環(huán)境因素(environment factors) 微量元素(microelement)：鎳(nickel) 維生素缺乏(vitamin lack) 性激素失調(diào)(hormonal factors) 亞硝胺A combination of genetic, virus and environmental influences would best expl

4、ain the occurrence of nasopharyngeal carcinoma)病理學(xué)(pathology)主要為低分化鱗癌。 少見腺癌、肉瘤等 Over 95% Squamous cell carcinoma( poorly differentiation)Adenocarcinoma, sarcoma, 好發(fā)部位most tumors arise on the posterosuperior wall or fossa of Rosenmuller 圖 咽隱窩 鼻咽頂后壁臨床表現(xiàn)(clinical manifestations)1、鼻部癥狀: 涕血或后吸涕帶血，鼻塞。nasa

5、l symptoms such as epistaxis, bloodypostnasal discharge, nasal obstruction2、耳部癥狀：分泌性中耳炎Secretory otitis media: conductivedeafness, fluid in the middle ear, tympanic membrane indrawn 3、頸淋巴結(jié)腫大（圖） 頸淋巴結(jié)腫大為首發(fā)癥狀60%，部位：頸深上淋巴結(jié)，先單側(cè)后雙側(cè)。頸淋巴轉(zhuǎn)移圖4、顱神經(jīng)癥狀:腫瘤咽隱窩破裂孔顱內(nèi)/ /腦神經(jīng)頭痛，面部麻木，眼球外展受限等/軟腭癱瘓，嗆咳，聲嘶，伸舌偏等。 舌下神經(jīng)麻痹 外展神經(jīng)

6、麻痹 Hypoglossal paralysis abducens paralysis 5、遠(yuǎn)處轉(zhuǎn)移：Distant metastases occur to bone, lung, liver and other sites 診斷(Diagnosis)1、病史、癥狀和體征History, symptoms and signsEarly symptoms: bloody postnasal discharge fluid in the middle ear (unilateral)2、鼻咽鏡檢查The posterior rhinoscopyFibreoptic nasopharyngoscop

7、y3、血清學(xué)檢查EBVCA-IgA, EBVEA-IgG4、影象學(xué)檢查Imaging CT, MRI5、鼻咽活檢確診的方法Definitive diagnosis is made by biopsy鑒別診斷(differenciate diagnosis)圖鼻咽纖維血管瘤(angiofibroma of nasopharynx)1. 1025y的青年男性；2. 鼻出血或口中吐血；3. 鼻阻塞；4. 其他；5. 禁活檢6.鼻鏡和影像學(xué)檢查治療(Treatment)放射治療: Radiotherapy is the method of choice. Prognosis: the overall 5-year survival rate is