35例眼眶受侵鼻咽癌临床分析

发布时间：2018-01-31 18:05

本文关键词： 鼻咽癌眼眶受侵　出处：《广西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：通过回顾性分析35例诊断眼眶受侵鼻咽癌患者的资料，探讨鼻咽癌眼眶受侵临床特点。方法：收集广西医科大学附属肿瘤医院2008年1月至2011年1月初治的诊断为眼眶受侵的鼻咽癌患者35例临床资料，所有患者治疗前均行详细体格检查、鼻咽及颈部CT或MRI检查、鼻咽纤维镜检查、鼻咽肿物活检及病理检查等。阅读患者病历资料、影像学资料，随访至2014年2月，分析眼眶受侵鼻咽癌的临床表现、影像学特点、主要侵犯途径和治疗结果，并探讨影响其预后的因素。结果：（1）鼻咽癌侵犯眼眶的发生率约3%。（2）35例患者中，有视力下降者15例（占42.8%），有复视者有15例（占42.8%），有突眼者7例（占20%），有斜视者1例（占0.03%），眼睑下垂者5例（占14%），，眼球固定者3例（占0.09%），瞳孔扩大者1例（占0.03%），无光反射消失病例，出现眼痛者12例（占34%）。出现前组颅神经损伤者有24例（占69%）。（3）鼻咽癌侵犯到眼眶的途径为：鼻咽—海绵窦—眶上裂或者眶尖（18/36）；鼻咽—翼腭窝—眶下裂或者眶尖（14/36）：鼻咽—筛窦—眶内侧壁（4/36）。（4）影像学表现：视神经异常：9例（9只眼）。眼外肌异常8例。球后肿块4例。眶尖及眶壁骨质异常28例。7例无骨质破坏者，其中5例表现为眶上裂或眶下裂增宽，2例眶内眼外肌或视神经受侵，但眶上裂、眶下裂、视神经孔无扩大。（5）全组患者1、2、3年生存率分别为97.1%、67.7%、50%。总体转移率约28.6%。结论（1）本组资料鼻咽癌侵犯眼眶发生率约3%。（2）突眼、视力下降、复视、眼痛、眼睑下垂为眼眶受侵最常见临床表现。鼻咽癌侵犯到眼眶增加了颅神经损伤风险。（3）鼻咽癌侵犯到眼眶主要途径为：1、鼻咽→海绵窦→眶上裂或者眶尖；2、鼻咽→翼腭窝→眶下裂或者眶尖：3、鼻咽→筛窦→眶内侧壁。（4）眼眶受侵鼻咽癌侵犯范围广、颅神经损伤多，预后较差，颅神经损伤条数、有无化疗为其独立预后因素，放疗技术应首选三维调强放疗。
[Abstract]:Objective: to investigate the clinical features of orbital invasion of nasopharyngeal carcinoma (NPC) by retrospective analysis of 35 cases of nasopharyngeal carcinoma (NPC). Methods: 35 cases of nasopharyngeal carcinoma with orbital invasion were collected from January 2008 to early January 2011 in affiliated Cancer Hospital of Guangxi Medical University. All patients underwent detailed physical examination, CT or MRI examination of nasopharynx and neck, nasopharyngeal fiberscope, nasopharyngeal mass biopsy and pathological examination before treatment. The clinical manifestations, imaging features, main invasion approaches and treatment results of orbital invasive nasopharyngeal carcinoma (NPC) were analyzed, and the prognostic factors were discussed. Results: The incidence of nasopharyngeal carcinoma invading orbit is about 3%. Of the 35 patients, 15 (42.8%) had vision loss, 15 (42.8%) had compound vision, 7 (20%) had protruding eyes. There were 1 case with strabismus (0.03%), 5 cases with blepharoptosis (14 cases), 3 cases with fixed eyeball (0.09%), 1 case (0.03%) with dilated pupil (0.03%). Eye pain occurred in 12 cases (34%) and anterior cranial nerve injury in 24 cases (69%). 3) nasopharyngeal carcinoma invades orbit through nasopharyngeal cavernous sinus-supraorbital fissure or orbital apex 18 / 36; Nasopharynx-pterygopalatine fossa-suborbital fissure or orbital apex 14 / 36: nasopharynx-ethmoid sinus-medial orbital wall 4 / 36. 4) Imaging findings: optic nerve abnormality in 9 cases, extraocular muscle abnormality in 8 cases, Retrobulbar mass in 4 cases, and orbital apex and orbital wall bone abnormality in 28 cases. In 5 cases, the supraorbital fissure or suborbital fissure was enlarged in 2 cases, but the supraorbital fissure, suborbital fissure and optic foramen were not enlarged. The survival rates of 1 and 3 years in the whole group were 97.1and 67.70.The overall metastasis rate was about 28.6%. Conclusion The incidence of nasopharyngeal carcinoma invading orbit was about 3%. The most common clinical manifestation of orbital invasion is oculomalgia, diplopia, ophthalmalgia and eyelid droop. The invasion of nasopharyngeal carcinoma into orbit increases the risk of cranial nerve injury. The main route of nasopharyngeal carcinoma invading orbit is 1: 1, nasopharynx. 鈫扖avernous sinus. 鈫扴upraorbital fissure or orbital apex 2, nasopharynx. 鈫扨terygopalatine. 鈫扴uborbital fissure or orbital apex: 3, nasopharynx. 鈫扙thmoid sinus. 鈫扢edial orbital wall. (4) Orbital invasion of nasopharyngeal carcinoma (NPC) was extensive, cranial nerve injury was more frequent, prognosis was poor, the number of cranial nerve injury strips, chemotherapy or not was its independent prognostic factor. Three-dimensional intensity modulated radiotherapy should be preferred for radiotherapy.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.63

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