CAJ | 학술논문

目的观察鼻咽癌颈部转移淋巴结诱导化疗前后的二维及彩色多普勒超声(CDFI)影像学表现,并预测转移淋巴结在序贯放疗后的近期疗效.方法 40例经病理和CT证实为鼻咽癌初治患者颈部转移性淋巴结65枚,运用超声观测其大小、收缩期峰值流速(PSV)、阻力指数(RI),并记录其内部血流分级,分别在化疗前、后及序贯放疗后1～2个月行超声检查,比较转移淋巴结各测值及疗效的差异.结果根据诱导化疗前后颈部转移淋巴结内血供改变分三组,血供改善组占55％(36/65),血供减少组和血供无变化组分别占23％(15/65)、22％ (14/65),诱导化疗及序贯放疗后淋巴结均缩小,化疗后平均退缩率在血供减少组、血供改善组、血供无变化组分别为52％、36％、25％,序贯放疗后分别为90％、81％、70％,三组间均呈递减趋势,差异有统计学意义(P＜0.05).化疗后淋巴结血供变化与化疗后退缩率间有相关性(r =0.572,P=0.000),与序贯放疗后退缩率间有相关性(r =0.553,P=0.000),化疗后淋巴结退缩率与序贯放疗后退缩率间有相关性(r =0.621,P=0.000).化疗后淋巴结RI均下降,与治疗前差异有统计学意义(P＜0.05)；化疗后血供减少组、血供改善组PSV与治疗前差异有统计学意义(P＜0.05),血供无变化组差异无统计学意义(P＞0.05).结论应用CDFI可清晰、准确地观察鼻咽癌颈部转移性淋巴结诱导化疗前后的变化,其中诱导化疗后血供、大小的变化可预测近期放化疗后的疗效.
목적 관찰비인암경부전이림파결유도화료전후적이유급채색다보륵초성(CDFI)영상학표현,병예측전이림파결재서관방료후적근기료효.방법 40례경병리화CT증실위비인암초치환자경부전이성림파결65매,운용초성관측기대소、수축기봉치류속(PSV)、조력지수(RI),병기록기내부혈류분급,분별재화료전、후급서관방료후1～2개월행초성검사,비교전이림파결각측치급료효적차이.결과 근거유도화료전후경부전이림파결내혈공개변분삼조,혈공개선조점55％(36/65),혈공감소조화혈공무변화조분별점23％(15/65)、22％ (14/65),유도화료급서관방료후림파결균축소,화료후평균퇴축솔재혈공감소조、혈공개선조、혈공무변화조분별위52％、36％、25％,서관방료후분별위90％、81％、70％,삼조간균정체감추세,차이유통계학의의(P＜0.05).화료후림파결혈공변화여화료후퇴축솔간유상관성(r =0.572,P=0.000),여서관방료후퇴축솔간유상관성(r =0.553,P=0.000),화료후림파결퇴축솔여서관방료후퇴축솔간유상관성(r =0.621,P=0.000).화료후림파결RI균하강,여치료전차이유통계학의의(P＜0.05)；화료후혈공감소조、혈공개선조PSV여치료전차이유통계학의의(P＜0.05),혈공무변화조차이무통계학의의(P＞0.05).결론 응용CDFI가청석、준학지관찰비인암경부전이성림파결유도화료전후적변화,기중유도화료후혈공、대소적변화가예측근기방화료후적료효.
Objective To observe the performance of two-dimensional echocardiography and CDFI of metastatic cervical lymph nodes in nasopharyngeal carcinoma before and after induction chemotherapy,and to predict the short-term effect of the lymph nodes after sequential chemoradiotherapy.Methods Forty patients with sixty-five metastatic cervical lymph nodes which were confirmed as nasopharyngeal carcinoma by biopsy and CT were studied.CDFI was used to observe its size,the peak systolic velocity (PSV),resistivity index (RI),and record its classification of blood flow before and after induction chemotherapy,after radiotherapy 1 to 2 months for ultrasound,respectively,and the measured values and short-term effect in cervical lymph node metastasized were compared.Results According to the changes of blood supply after induction chemotherapy,lymph nodes were divided into three groups,the group of improve blood supply was given priority (55 ％),blood supply to reduce and no change groups were 23 ％,22％,respectively.After induction chemotherapy and sequential radiotherapy,all lymph nodes were narrow,regression rate after induction chemotherapy in blood supply to reduce,improve and no change groups were 52％,36％,25％,respectively,the regression rates of sequential chemoradiotherapy were 90％,81％,70％,respectively,among three groups are in degressive tendency,differences were significant (P ＜ 0.05).The blood supply changes after induction chemotherapy related well with the regression rate of chemotherapy(r =0.572,P =0.000) and sequential radiotherapy(r =0.553,P =0.000).The regression rate of chemotherapy related well with the regression rate of sequential chemoradiotherapy(r =0.621,P =0.000).After chemotherapy three groups of lymph node RI decreased,the difference was significant compared with that before treatment (P ＜ 0.05).After chemotherapy the groups to reduce and improve of PSV had significant differences compare with that before treatment (P ＜ 0.05),the group of blood supply no change of PSV had no significant difference (P ＞ 0.05).Conclusion Application of CDFI can clearly and accurately observe changes of metastatic cervical lymph nodes from nasopharyngeal carcinoma before and after induction chemotherapy,and the changes of blood supply and size after induction chemotherapy can predict the short-term effect after chemoradiotherapy.