鼻咽纤维血管瘤的临床与CT诊断分析.DOCVIP

临床医学论文-鼻咽纤维血管瘤的临床与CT诊断分析 【关键词】? 鼻咽纤维血管瘤；X线；计算机断层扫描 ??? ［摘? 要］ 目的：探讨鼻咽纤维血管瘤的CT表现及对临床诊断的价值。方法：回顾分析经手术和病理证实的16例鼻咽纤维血管瘤的临床与CT表现、诊断及Chandler分期。结果：鼻咽纤维血管瘤CT平扫多表现为等或稍低密度，与周围分界不清，增强扫描肿瘤增强极显著，边界清楚，常伴有骨质受压和吸收，肿瘤侵犯部位按Chandler标准Ⅰ期4例、Ⅱ期3例、Ⅲ期4例、Ⅳ期5例。CT诊断准确率为93.2%。结论：CT对鼻咽纤维血管瘤可作出明确诊断及分期，应作为本病的首选检查方法。 　　［关键词］ 鼻咽纤维血管瘤；X线；计算机断层扫描 　　Clinic and CT Diagnosis of Nasopharyngeal Angiofibroma 　　Abstract:Objective To study the CT manifestations of nasopharyngeal angiofibroma(NPAF) and its value in clinical diagnosis and treatment.Methods 16 case ofNPAF were retrospectively analyzed with their CT features,clinical and CT diagnosis and Chandler stage.Results On CT plane scan,NPAF were isodensity or slight hypodensity and could not be differentiated from surrounding tissue.On enhancement CT scan,NPAF were grossly enhanced and could be clearly differentiated from surrounding structures.Most case showed either slight or remarkable pressure and bone destruction over the base of skull.According to Chandler classification,there were 4 cases of stage Ⅰ,3 cases of stage Ⅱ,4 cases of stage Ⅲ ang 5 cases of stage Ⅳ.CT diagnosis accurate rate is 93.2%.Conclusion CT can provide accurate diagnosis and stage for NPAF and has high value in surgical management.CT can be used as the first choice of examination for NPAF. 　　Key words:Nasopharyngeal angifibroma；Xray；Computed tomography ??? 鼻咽纤维血管瘤（nasopharyngeal angiofibroma，NPAF）又名男性青春期出血性纤维瘤，是鼻咽顶部后鼻孔区最常见的良性肿瘤。术后复发率高，根治困难，但早期诊断和治疗可以取得较好的效果。笔者报告本院2003年至2005年间收治的16例NPAF临床及CT检查资料，以提高对本病的诊治水平。 　　1? 资料和方法 　　1.1? 临床资料? 16例均为男性，年龄9岁～43岁，平均17岁，所有病例都有鼻塞和反复鼻出血，伴有流涕10例，呼吸困难6例，嗅觉减低5例，听力下降3例，视力下降2例，面颊部肿胀4例，4例为手术后复发。查体均于鼻腔后部可见红色肿物，表面光滑或呈结节状，表面有血管纹，触诊肿块质硬，易出血。 　　1.2? 仪器设备与检查方法? 采用德国SIEMENS公司，Somatom Sensation4 全身CT扫描机，层厚和层距均为5 mm，均扫描轴位和冠状位，先平扫后增强扫描，造影剂位300 mgI/ml×100 ml的优维显。常规照软组织窗像和骨窗像。肿瘤按Chandler［1］标准进行分期：Ⅰ期肿瘤局限于鼻咽部；Ⅱ期肿瘤扩展至鼻腔和蝶窦；Ⅲ期肿瘤扩展至上颌窦、筛窦、翼腭窝、颞下窝、眼眶（眶上裂、眶下裂、眶内），颊部；Ⅳ期肿瘤侵入颅内。 　　2? 结果 　　肿瘤部位：鼻咽顶部后鼻孔区12例，鼻腔4例，其中左侧10例，右侧6例。肿瘤大小：3 cm以下3例，3 cm～5 cm 7例，5 cm以上6例。肿瘤侵犯部位：按Chandler