儿童及青少年鼻咽恶性肿瘤20例临床病例分析

Nasopharyngeal malignant tumor in 20 children and adolescent patients: a retrospective study

摘要:

摘要：目的 分析儿童及青少年鼻咽部恶性肿瘤的病理学特点、临床表现、诊治过程及误诊情况，探讨诊疗中值得关注的问题。方法 回顾南京医科大学第一附属医院（江苏省人民医院）2015 年01月-2022 年12 月诊治的1480例儿童及青少年鼻咽部病变患者，其中恶性肿瘤20例（1.35%），良性肿瘤5例（0.34%），炎性病变1455例（98.31%）。汇总并分析鼻咽恶性肿瘤患者的临床表现、病理学类型及诊疗过程等，探讨诊断过程存在的问题和疏漏。结果 鼻咽部恶性肿瘤包括鳞状细胞癌16例，淋巴瘤2例，乳头状腺癌1例，脊索瘤1例。这些患者的发病年龄高于炎性病变患者，差异有统计学意义（Z= -6.762，P <0.001）；男性多发，与炎性病变患者性别差异有统计学意义（χ2=4.105 ，P<0.05）。恶性肿瘤病例的初期临床症状以鼻部为主的共7例，其中4例被误诊为腺样体肥大；以耳部为主的共5例，其中2例被误诊为单纯分泌性中耳炎；以颈部为主的共8例，未见误诊。总误诊率达30%。误诊患者的确诊前病程长于非误诊患者，差异有统计学意义（Z= -3.160，P <0.01）。以颈部症状为主的患者确诊前病程短于以鼻部症状为主的患者（Z= -2.078，P <0.05）和以耳部症状为主的患者（Z= -2.372，P <0.05），差异有统计学意义。结论 多种鼻咽恶性肿瘤可能发生在儿童及青少年人群且通常无特异性临床表现，其中以鼻部和耳部症状为主的患者尤其容易被误诊，临床上应注意鉴别。

Abstract:

Abstract：Objective To analyze the pathological features as well as the clinical manifestations, diagnosis and treatment of malignant tumors in children and adolescent patients. Methods A retrospective analysis was conducted on 1480 children and adolescent patients with nasopharyngeal lesions from January 2015 to December 2022. There were 20 patients (1.35%) with malignant tumor, 5 patients (0.34%) with benign tumor, and 1455 patients (98.18%) with inflammatory disease. The presenting symptoms, pathological features and clinical data of patients (1.35%) with malignant tumor were analyzed respectively. Results The malignant tumors group included 16 squamous cell carcinoma, 2 lymphoma, 1 papillary adenocarcinoma, and 1 chordoma. The onset age of malignant tumor patients was higher than that of the inflammation patients (Z=-6.762, P<0.001). The difference in gender between the inflammatory and the malignant tumor was statistically significant (χ2=4.105, P<0.05). The misdiagnosis rate of malignant tumors reached 30% because 4 cases with mainly nasal symptoms were misdiagnosed as adenoid hypertrophy, and 2 cases with mainly ear symptoms were misdiagnosed as secretory otitis media. The disease course of misdiagnosed patients was longer than that of non-misdiagnosed patients (Z=-3.160, P<0.01). The duration of the disease before diagnosis in the patients with neck symptoms was shorter than that in the patients with mainly nasal symptoms (Z=-2.078, P<0.05) or with mainly ear symptoms (Z=-2.372, P<0.05). Conclusions Several nasopharyngeal malignancies may occur in the children and adolescents, and usually have no specific clinical manifestations. And those should be distinguished carefully, especially in patients with only nasal and/or ear symptoms.