下咽癌的CT诊断与鉴别

CT diagnosis and differential diagnosis of hypopharyngeal carcinoma

摘要:

目的：探讨下咽癌的CT特点并与其它下咽部病变进行鉴别。方法：对21例下咽癌和需要与其鉴别的下咽部病变CT表现进行回顾性分析，所有病例都经手术或活检病理证实。结果:下咽癌13例，其中梨状窝癌10例，咽后壁癌2例，环后区癌1例。下咽部炎症5例；下咽部囊肿、下咽部淋巴瘤及会厌披裂息肉各1例。下咽癌主要表现为一侧梨状窝或咽后壁环后区软组织密度团块结节影及咽壁增厚，不均匀强化，常致杓、环-椎距增宽（≥1 cm），可侵犯喉内及喉旁结构、咽旁及邻近颈部软组织，破坏喉软骨，累及食道入口及颈部淋巴结转移。结论：CT可有效观察下咽癌的位置、形态、大小、侵犯范围及淋巴结转移情况。杓、环-椎距增宽是下咽癌较为特征性的表现，但需要与其它一些下咽部病变鉴别。

Abstract:

Objective：To explore the computed tomography（CT） feature of hypopharyngeal carcinoma and investigate its differentia－tion from other hypopharyngeal diseases. Methods：CT findings of 21 cases of hypopharyngeal carcinoma and other hypopharyngeal diseases which are necessary to differentiate from hypopharyngeal carcinoma were retrospectively analyzed，all of which were con－firmed by surgery or pathology. Results：Of 21 cases，there were 13 cases of hypopharyngeal carcinoma，5 cases of hypopharynx in－flammation，1 case of hypopharyngeal cyst，1 case of hypopharyngeal lymphoma and 1 case of hypopharyngeal polyp. Of the 13 cases of hypopharyngeal carcinoma，CT found location at pyriform sinus in 10 cases，at posterior wall of hypopharynx in 2 cases，at postcricoid in 1 case. The main manifestations of hypopharyngeal carcinoma were soft tissue density mass located at one side of pyri－form sinus or retropharynx or postcricoid，thickening of retropharyngeal soft tissue，inhomogeneous enhancement，usually widening of cricoid cartilage-vertebra or arytenoid cartilage-vertebra distance（≥1 cm），involving larynx and neighboring structures，parapharyngeal structures and adjacent cervical soft tissue，destructed laryngeal cartilage，invaded esophagus and metastasis of cervical lymph nodes. Conclusion：CT is useful for observing the site，shape，size and invasive extent of hypopharyngeal carcinoma as well as lymph node metastases.The widening of cricoid cartilage-vertebra or arytenoid cartilage-vertebra distance is the characteristic feature of hypopha－ryngeal carcinoma and necessary to differentiate from other hypopharyngeal diseases.