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目的应用彩色多普勒超声分析放疗前后鼻咽癌颈部转移淋巴结二维特征、分布区域、内部血流类型等,旨在探讨鼻咽癌颈部淋巴结转移变化的规律,为临床治疗方案的制定与疗效判断、评估预后等提供重要参考依据。方法回顾性分析作者医院2013年1~12月放射治疗前、后3个月内,有2次以上完整超声影像学检查记录,经鼻咽部病灶组织病理学确诊的67例鼻咽癌患者的临床资料。结果放疗前:87.3%转移淋巴结位于患者的Ⅱ、Ⅲ、Ⅴ区域,转移淋巴结病灶大多呈现为类圆形,长短径之比(L/S)1.78±0.67,63.6%转移淋巴结的门部结构遭到破坏,皮髓质发生变形或显示不清。81.8%转移淋巴结血流分布类型以周边型及混合型为主,血流阻力指数0.72±0.08。放疗后:78.2%病灶消失,残留颈部淋巴结病灶长短径之比(L/S)为1.39±0.46;全部残留病灶淋巴门消失或不清,血流明显减少或消失,血流阻力指数0.67±0.05。结论咽后淋巴结(Ⅲ、Ⅴ区)和颈深上区淋巴结(Ⅱ区)均为鼻咽癌前哨淋巴结,鼻咽癌颈淋巴结常转移至此区域。鼻咽癌颈部转移淋巴结的近期疗效与其淋巴结的血供情况呈正相关,而与淋巴结大小呈负相关。运用彩色多普勒超声观察鼻咽癌患者放疗前后颈部淋巴结转移的变化情况具有较高的临床价值。
Objective To analyze the two-dimensional characteristics of cervical lymph node metastasis before and after radiotherapy by color Doppler echocardiography, distribution area and internal blood flow types, so as to explore the rule of cervical lymph node metastasis of nasopharyngeal carcinoma, and to establish the clinical treatment plan With the judgment of curative effect, evaluate the prognosis and provide important reference. Methods Retrospective analysis of the author hospital from January 2013 to December before radiation therapy within 3 months, there are more than 2 complete ultrasound imaging records, nasopharyngeal lesions histopathologically confirmed 67 cases of nasopharyngeal carcinoma patients clinical information. Results Before radiotherapy, 87.3% of the metastatic lymph nodes were located in the region of Ⅱ, Ⅲ and Ⅴ of the patients. Most of the metastatic lymph nodes presented as round, short / long ratio (L / S) 1.78 ± 0.67, 63.6% To damage, cortical deformation or unclear display. 81.8% of the metastatic lymph nodes blood flow distribution type peripheral and mixed type, blood flow resistance index 0.72 ± 0.08. After radiotherapy, 78.2% of the lesions disappeared and the ratio of the length to the diameter of the remaining cervical lymph nodes (L / S) was 1.39 ± 0.46. The lymphatic stoma of all residual lesions disappeared or was unclear, the blood flow decreased or disappeared obviously, and the blood flow resistance index was 0.67 ± 0.05. Conclusions The posterior node lymph nodes (Ⅲ and Ⅴ) and the upper cervical lymph nodes (Ⅱ) are all sentinel nodes of nasopharyngeal carcinoma. The cervical lymph nodes of nasopharyngeal carcinoma frequently metastasize to this area. The recent efficacy of cervical lymph node metastasis of nasopharyngeal carcinoma is positively correlated with the blood supply of lymph nodes, but negatively with the size of lymph nodes. The use of color Doppler ultrasound nasopharyngeal carcinoma patients with cervical lymph node metastases before and after the change has a high clinical value.