鼻咽癌 耳鼻咽喉-头颈外科 .pptVIP

鼻 咽 癌 Nasopharyngeal Carcinoma (NPC) 耳鼻咽喉-头颈外科 杨新明 一、概述(outline) 1、发病有一定的地区性(more common in south-east Asia in the world, more common in southern China) 我国头颈恶性肿瘤之冠(the top of the malignant tumor in head and neck)。某些高发区可能为全身恶性肿瘤之首，广东、广西、湖南和福建高发。 2、高发年龄（maximum age incidence)：40~60岁（86.62%） 3、性别(sex)：男多于女(male to female is 2:1) 二、病因（etiology)(three possible causal factors) 1、遗传因素(genetic factors) 种族易感性 家族聚集性 (racial predilection, family tendency and HLA typing) 2、病毒因素----Epstein-Barr virus EB病毒 NPC患者血清中检测到EB病毒相关抗体(patients with NPC have high level of antibody against EBV(over 90% of patients) ， NPC活组织的癌细胞中存在EBV DNA特异性mRNA或基因表达产物(expression of gene products， (but whether the relationship between the two is causal or incidental is still unknown) 3、环境因素(environment factors) 微量元素(microelement)：镍(nickel) 维生素缺乏(vitamin lack) 性激素失调(hormonal factors) 亚硝胺 A combination of genetic, virus and environmental influences would best explain the occurrence of nasopharyngeal carcinoma) 病理学(pathology) 主要为低分化鳞癌。 少见腺癌、肉瘤等 Over 95% Squamous cell carcinoma( poorly differentiation) Adenocarcinoma, sarcoma, 好发部位most tumors arise on the posterosuperior wall or fossa of Rosenmuller 图 咽隐窝 鼻咽顶后壁 临床表现(clinical manifestations) 1、鼻部症状: 涕血或后吸涕带血，鼻塞。 nasal symptoms such as epistaxis, bloody postnasal discharge, nasal obstruction 2、耳部症状：分泌性中耳炎 Secretory otitis media: conductive deafness, fluid in the middle ear, tympanic membrane indrawn 3、颈淋巴结肿大（图） Metastases in the lymph nodes of the neck , regional nodal metastases are present in 60 to 80 per cent of patients, with bilateral spread being evident in almost half. Superior deep jugular nodes are most often noted 颈淋巴转移 图 4、颅神经症状:（图）involved cranial nerves: fifth and sixth nerve are the most frequently involved, Headache, internal strabismus. 4th , 3rd and 2nd cranial nerves are next most commonly affected. 9th, 10th 11th and 12th may also be involved