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[目的]探讨初治鼻咽癌患者腮腺淋巴结转移的临床特点及高危因素。[方法]2008年1～10月,372例病理学证实的初治鼻咽鳞癌患者接受放射治疗,其中234例为调强放射治疗。所有患者在治疗前及治疗近结束时均行MRI扫描,调强放射治疗患者均加做增强定位CT扫描。回顾性分析以上病例影像学资料,分析腮腺淋巴结转移病例临床特点及高危因素。[结果]10例(2.7%)初治鼻咽癌(均为Ⅲ期或Ⅳ期)发生腮腺淋巴结转移。90%发生在鼻咽主要病变一侧。40%为腮腺内多发肿大淋巴结,60%为单发病变。影像学上可分为鼻咽原发病变直接侵犯、邻近淋巴结引流区有巨大转移淋巴结及无腮腺侵犯的孤立性淋巴结转移三类。[结论]Ⅲ～Ⅳ期鼻咽癌、鼻咽原发病变侵及腮腺深叶、邻近淋巴引流区巨大淋巴结转移或包膜外侵犯为鼻咽癌腮腺淋巴结转移的高危因素,应警惕腮腺淋巴结转移可能,不应过分强调患侧腮腺保护。
[Objective] To investigate the clinical features and risk factors of parotid lymph node metastasis in newly diagnosed nasopharyngeal carcinoma patients. [Method] From January to October 2008, 372 nasopharyngeal squamous cell carcinoma patients with pathologically confirmed nasopharyngeal carcinoma were treated with radiotherapy, of which 234 cases were treated with IMRT. All patients underwent MRI scans before and near the end of treatment, and all patients underwent enhanced CT scans with IMRT. The above imaging data were retrospectively analyzed to analyze the clinical features and risk factors of parotid lymph node metastases. [Results] Parotid lymph node metastasis occurred in 10 patients (2.7%) with nasopharyngeal carcinoma (both stage Ⅲ or Ⅳ). 90% occurred in the main lesion side of the nasopharynx. 40% of multiple parotid swollen lymph nodes, 60% of single lesions. Imaging can be divided into direct invasion of the primary nasopharyngeal lesions, adjacent lymph node drainage area has a huge lymph node metastasis and parotid gland invasion of isolated lymph node metastasis. [Conclusion] The primary stage Ⅲ ~ Ⅳ nasopharyngeal carcinoma, primary nasopharyngeal invasion and parotid gland deep lobes, adjacent lymph drainage area of the large lymph node metastasis or extracapsular invasion of nasopharyngeal parotid lymph node metastasis risk factors should be alert to parotid gland lymph node metastasis Probably parotid protection should not be overemphasized.