- 期刊
- OpenAccess
梨狀竇癌的電腦斷層攝影所見
Computed Tomography in Pyriform Sinus Carcinoma
摘要
從民國74年2月至77年4月，長庚紀念醫院共有22例經病理證實為梨狀竇癌(pyriform sinus carcinoma)的病例接受頸部斷層攝影（computed tomography以下簡稱CT）檢查。其中男性佔21例，女性只有1例。本文主要描述分析其CT所見，目的為試從CT去探討梨狀竇癌的深層擴展(deep extension)。綜合主要的CT表徵包括：(1)擴展到喉外軟組織(extralaryngeal soft tissue)有16例(72.7%)；(2)蔓延至會厭前空間(pre-epiglottic space)有12例(54.5%)，但只有3例越過中線；(3)環狀甲狀軟骨空間(cricothyroid space)變寬有15例(68.2%)；(4)甲狀軟骨(thyroid cartilage)被侵蝕破壞有12例(54.5%)和(5)淋巴結的轉移有16例(72.7%)。 有時一些喉部結構只是被鄰近腫瘤壓迫，導致移位和變形，在CT看來卻很像已被腫瘤浸潤，造成本文中的8個偽陽性的CT表徵，包括3個發生在杓狀會厭皺襞(aryepiglottic fold)，3個在假聲帶和2個在真聲帶。另外，甲狀軟骨和淋巴結的顯微性侵犯：(microinvasion)，CT是無法顯示出來，分別造成2個偽陰性的CT表徵。 由梨狀竇癌的CT所見，可以了解其擴展範圍及形態；對手術治療的切除範圍、病情的預後以及頸部腫瘤的鑑別診斷，可提供很有價值的資料。可是，必須充分明瞭一些判讀上的潛在錯誤，才能提高CT的準確率。
並列摘要
From February 1985 to April 1988, 22 patients with pathologically proved pyriform sinus carcinoma were examined by computed tomography (CT) in Chang Gung Memorial Hospital. The purpose was to assess the deep extension of the pyriform sinus carcinoma. The CT findings mainly included: 1. extralaryngeal soft tissue extension in 16 cases (72.7%); 2. involvement of the pre-epiglottic space in 12 cases (54.5%); 3. widening of the cricothyroid space in 15 cases (68.2%); 4. thyroid cartilage destruction in 12 cases (54.5%); 5. lymph node metastasis in 16 cases (72.7%)。 Mass effect from bulky pyriform sinus tumor distorted the adjacent normal structures, simulating tumor involvement in some instances and causing 8 false positive CT findings in our study. Of these 8 false positives, 3 occured in gryepiglottic fold, 3 in false cord and 2 in true cord. Microinvasion of thyroid cartilage and lymph node was not detected by CT, creating 2 false negatives respectively. In this study, CT can reveal the gross size and extension of the tumor. It is of great value in deciding the extent of the surgical resection and in predicting the prognosis of the disease. However, in order to improve the diagnostic accuracy, some pitfalls in CT interpretation should be understood.
延伸閱讀
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