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| 摘要 目的 探讨鼻咽部常见疾患临床表现特点及其发病趋势，为鼻咽部疾病的诊断与鉴别诊断提供依据。方法 回顾性分析研究1990年2月～今年12月165例鼻咽部疾患的临床资料。结果 鼻咽部疾病出现率由高到低依次是：鼻咽癌、增殖体肥大、恶性淋巴瘤、鼻咽结核、鼻咽纤维血管瘤和脊索瘤；发病年龄以30岁以下和30岁～60岁为主；鼻咽癌、纤维血管瘤、脊索瘤中男性明显多于女性；临床症状主要为鼻塞、闭塞性鼻音(67.88%)、回吸性涕中带血(55.76%)；鼻咽部检查以结节性病变为主(62.42%)，且主要位于鼻咽顶后壁(75.15%)；鼻咽部疾病颈部肿块的发生率约为38.18%;经病理证实的临床误诊率为35.15%。结论 鼻咽部疾患发病以青、中年居多，男性有多于女性之趋势；鼻咽部肿物中鼻咽癌出现率很高。鼻咽部疾病临床误诊率较高，鼻咽结核尤为显著；结节性病变系鼻咽疾患的主要体征；依靠临床症状、体征、局部活检及相应的辅助检查等综合手段可以提高鼻咽部疾患的诊断率，降低误诊率。 关键词 鼻咽部 肿块 鼻咽肿瘤 诊断 鉴别诊断 Diagnostic experience in the several kinds of nasnopharyngeal malady:a analysis of 165 cases Abstract Objective To evaluate the trends and the clinical characteristics in several nasopharyngeal diseases,p-roviding credible gists for diagnosis and differential diagnosis of nasopharyngeal diseases.Methods The clinical data of 165 patients with nasopharyngeal pathological changes from Feb. 1990 to Dec.2003 in Fengtai hospital and Jilin center hosptial were studied retrospectively.Results The emergence of the nasopharyngeal diseases was as follow in file: nasopharyngeal carcinoma(32.12%)，adenoidal hypertrophy(19.39%)，malignant lymphoma(16.97%)，naso-pharyngeal tuberculosis(15.15%),angiofibroma of nasopharynx(10.91%), nasopharyngeal chordoma(5.45%); The at-tack age was less than 30 & ranging from 30 to 60 years mainly;Of nasopharyngeal carcinoma, angiofibroma of nasop-harynx,nasopharyngeal chordoma, the male cases were more than the females; The clinical symptoms were mainly co-mposed of nasal snuffle, obturately nasolalia(67.88%), resorbent snot with bleed(55.76%); Major pathological chan-ges of nodus were found in nasopharyngeal region(62.42%), which mainly located in rearward & top walls of nasop-harynx section. The incidence of a lump in the neck in nasopharyngeal cases was 38.18%.The misdiagnosis was 35.15%, as was comfirmed via pathological examination. Conclusion (1) The incidence of nasopharyngeal disease was more in adult and youth, male patients were more than female ones;(2) Of nasopharyngeal lump, the incidence of nasopharyngeal carcinoma was much higher, and also higher in North China;(3) The misdiagnosis rate was more for nasopharyngeal cases, especially nasopharyngeal tuberculosis;(4) Nodus pathophy was main clinical presentation of nasopharynx diseases;(5) Depend on the clinical symptoms, presentation, local biopsy, and corresponding adjuvant check-up, etc,the diagnosis rate of nasopharyngeal illness may be increased, and the misdiagnosis may be Deereased. Key words Nasopharynx; Lump;Nasopharyngeal neoplasms; Diagnosis;Differential diagnosis 鼻咽部疾病的发病率有逐年攀升的趋势。因鼻咽部解剖位置较深，临床发现其中的早期病变比较困难；又因鼻咽部病变隐匿，早期临床症状轻微不易引起病人及其家属的重视,因而误诊率比较高。作者通过对以往诊治的165例鼻咽部肿物的临床病例进行回顾性分析，认为在临床工作中，除理论上提高对这类疾病的认识外，还应结合临床症状、体征，凭籍相应的CT检查以及局部活检术可以观察到鼻咽部的表层及其周围结构，有益于鼻咽部疾病的早期诊断，提高诊断的准确率。 1 资料与方法 1.1 临床资料 收集1990年2月～今年12月经病理证实的鼻咽部肿物病例165例。病例分别来自北京丰台医院89例,吉林中心医院76例；其中男性104例，女性61例，男女之比为1∶0.59；年龄5岁～82岁，平均27.8岁，30岁以下有92例，30岁～60岁占60例，60岁以上13例。上述病例中有65例于手术、放疗等治疗前接受活组织检查,占同期病例的39.39%。165例患者经术前活检及手术后病理证实鼻咽癌53例(32.12%)，鼻咽部结核25例（15.15%），增殖体肥大32例(19.39%)，鼻咽部纤维血管瘤18例(10.91%)，鼻咽部恶性淋巴瘤28例(16.97%)，鼻咽脊索瘤9例(5.45%)。以上病例分别给予放射、抗痨、手术治疗或化疗。 本组病例中有58例术前诊断有误。 1.2 方法 所有数据采用SPSS10.0统计软件包分析，组间、组内差异采用卡方(χ2)检验、方差分析。 2 结果 2.1 165例患者各疾病年龄构成比 见表１。如表1所示，30岁以下人群鼻咽癌和鼻咽脊索瘤出现率明显低于其他4种疾患(χ2值=29.86,P<0.05)，其中增殖体肥大和鼻咽纤维血管瘤出现率最高; 30岁～60岁人群相对出现率较高的为鼻咽癌和鼻咽部脊索瘤，与其他几种疾病比较差异显著(χ2值=37.46，P<0.01)；60岁以上人群以鼻咽癌、鼻咽结核、恶性淋巴瘤多见，增殖体肥大、鼻咽纤维血管瘤及脊索瘤未检出。 表 1-1 165例鼻咽部疾病患者年龄构成情况
表 1-2 165例鼻咽部疾病患者年龄构成情况
2.2 165例病人性别构成比较 见表2。收集资料齐全的病人中男性104例,女性61例，虽男性有多于女性之趋势，但统计学处理差异不显著(χ2=5.34, P>0.05)。组内比较鼻咽癌、纤维血管瘤及脊索瘤中，男性均明显多于女性，经统计学处理，差异具有显著性(P<0.05)。 表2 165例鼻咽部肿物患者性别构成比较
2.3 研究病例中各疾病的出现率 见表3。组间相比，鼻咽癌明显高于其他疾患(P<0.05)， P<0.01(与脊索瘤相比),鼻咽脊索瘤明显低于其他疾患(P<0.05)。 表3 165例鼻咽部肿物患者疾病发现率（%）比较
2.4 临床诸症状构成比例 见表4。鼻咽癌中出现最多的症状是回吸性涕中带血、鼻出血，闭塞性鼻音、鼻塞，分别占77.36%（41/53）、69.81%（37/53）；鼻咽部结核最多的症状是鼻咽部异物感（72%，18/25）；增殖体肥大以鼻塞、闭塞性鼻音多见（90.63%,29/45）；鼻咽纤维血管瘤出现较多的症状是涕中带血、鼻衄（88.89%，16/18）；鼻咽部恶性淋巴瘤也以鼻衄或涕中带血为主要临床表现（78.57%，22/28）；鼻咽脊索瘤出现较多的症状有鼻塞、闭塞性鼻音(88.89%，8/9)和耳鸣及听力损失(66.67%，6/9)。
表4-2 165例鼻咽部疾病患者临床病理因素构成比
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