鼻咽上皮细胞癌变的“醋白反应”特点及舌象表现

发布时间：2018-12-20 05:37

【摘要】： 我国鼻咽癌患者约占全世界的80%,广东省是鼻咽癌的高发地区之一,严重影响该地区人民健康,病理诊断是鼻咽癌确诊的金标准,病检给疑似鼻咽癌患者带来不必要的痛苦,本研究通过收集鼻咽癌高发区经过醋酸染色的病人资料,为提高鼻咽癌活检准确性和阳性率做出一定的贡献。研究目的：本研究旨在探讨醋白反应对疑似鼻咽癌患者是否需要活检及活检部位选取的临床意义。研究方法：病例来源于鼻咽癌高发区广州中医药大学附属中山市中医院耳鼻喉科门诊就诊的患者,时间从2007年9月～2009年6月共189例,包括鼻咽癌19例,年龄24岁到75岁,平均年龄47.3岁,男15例,女4例；鼻咽上皮异型化生者16例,年龄25岁到56岁,平均年龄38.9岁,男9例,女7例；鼻咽炎47例,年龄19岁到62岁,平均年龄39.9岁,男20例,女27例。对照人群共107例,为健康志愿者,年龄14岁到82岁,平均年龄38.1岁,男60例,女47例。以2%醋酸溶液涂于鼻咽部病变区,分别于即时、1分钟后在纤维喉镜下观察鼻咽部粘膜的着色情况并采集图像供分析,同时也对部分病人的舌象进行了收集整理分析。结果：不同鼻咽疾病出现不同程度的醋白反应,依病理恶性程度的增加醋白反应呈增强反应,鼻咽癌、鼻咽炎伴上皮化生者,其醋白反应阳性率分别为：89.5%、93.8%、而鼻咽炎及健康志愿者二组人群未出现明显的醋白反应,其醋白反应阳性率分别为：38.3%、4.7%。x2=115.2,p0.001。正常舌在健康对照者较多,占了总人数的50%,而鼻咽炎及伴化生者相对要少,而鼻咽癌组最少,只有28.5%。而病理舌象(舌淡及舌红)在鼻咽癌、鼻咽炎及伴化生者相对增多,而在健康对照者相对减少。结论：鼻咽内镜下醋白反应对鼻咽上皮细胞癌变有一定的诊断价值,醋白反应可用于指导鼻咽可疑病变的初步临床判断,以决定是否需要活检及确定相对较准确的活检部位,最终提高鼻咽癌病检的准确性和阳性率。
[Abstract]:The number of NPC patients in China accounts for about 80% of the world. Guangdong Province is one of the areas with high incidence of NPC, which seriously affects the health of the people in this region. Pathological diagnosis is the gold standard for the diagnosis of nasopharyngeal carcinoma, and the examination of the disease causes unnecessary suffering to suspected NPC patients. In order to improve the accuracy and positive rate of nasopharyngeal carcinoma biopsy, we collected the data of patients with high incidence of nasopharyngeal carcinoma after acetic acid staining. Objective: to investigate the clinical significance of vinegar-white reaction in patients with suspected nasopharyngeal carcinoma (NPC). Methods: the patients were selected from the otolaryngology clinic of Zhongshan traditional Chinese Medicine Hospital affiliated to Guangzhou University of traditional Chinese Medicine in the high incidence area of nasopharyngeal carcinoma. From September 2007 to June 2009, 189 cases, including 19 cases of nasopharyngeal carcinoma, aged 24 to 75 years, were included. The average age was 47.3 years, 15 males and 4 females; There were 16 cases of nasopharyngeal epithelial dysplasia, ranging from 25 to 56 years old, with an average age of 38.9 years (9 males and 7 females) and 47 cases of nasopharyngitis (19 to 62 years old) with an average age of 39.9 years (20 males and 27 females). There were 107 healthy volunteers, aged from 14 to 82 years, with an average age of 38.1 years, 60 males and 47 females. 2% acetic acid solution was applied to the nasopharynx lesion area. The staining of nasopharyngeal mucosa was observed under fibrolaryngoscope 1 minute later, and the images were collected and analyzed. At the same time, the tongue images of some patients were collected and analyzed. Results: different degree of vinegar white reaction appeared in different nasopharynx diseases, and increased according to pathological malignancy. The positive rate of vinegar white reaction in nasopharyngeal carcinoma, nasopharyngeal inflammation with metaplasia was 89.55% and 93.8%, respectively. However, there was no obvious vinegar white reaction in the two groups, and the positive rate of vinegar white reaction was 38.3% 4.7.x2n115.2p0.001, respectively. The normal tongue was more in the healthy control group, accounting for 50% of the total number, while the nasopharyngitis and associated metaplasia were relatively less, while the nasopharyngeal carcinoma group was the least, only 28.5%. The pathological tongue (light tongue and red tongue) in nasopharyngeal carcinoma, nasopharyngitis and associated metaplasia increased, but in the healthy control group relatively decreased. Conclusion: the vinegar white reaction under nasopharynx endoscope has certain diagnostic value for nasopharyngeal epithelial cell carcinogenesis. Vinegar white reaction can be used to guide the preliminary clinical judgement of suspected nasopharynx lesions in order to determine the need for biopsy and to determine the relatively accurate biopsy site. Finally, the accuracy and positive rate of nasopharyngeal carcinoma were improved.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R739.63

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