放射性颞骨骨坏死的临床分型和治疗  

Clinical classification of osteoradionecrosis of temporal bone and the treatment of massive osteonecrosis

作　　者：林枫[1,2] 虞幼军[1,2] 陈伟雄[1,2] 梁海荣[1,2] 刘振[1,2] 郑立岗[1,2] 姚清华[1,2] 谢雪颜[1,2] 王跃建[1,2] 

机构地区：[1]中山大学附属佛山医院 [2]佛山市第一人民医院耳鼻咽喉头颈外科,广东佛山528000

出　　处：《临床耳鼻咽喉头颈外科杂志》2012年第1期1-4,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨放射性颞骨骨坏死的临床分型和有效治疗方案,为今后的治疗提供经验。方法:回顾性分析27例广泛性放射性颞骨骨坏死的治疗方法并进行临床分型,其中手术治疗15例,非手术治疗12例。结果:15例接受手术者中,4例死亡(3例术后1年多死于颈内动脉破裂大出血,1例术后4年死亡,死因不详);2例失访;另9例生存者中,1例术后随访8年,1例4年多,4例2～3年,1例1年以上,2例小于1年。手术以Ⅲ型疗效最好,Ⅴ型及Ⅳ型中病变未累及颈内动脉者疗效好,Ⅳ型中病变累及颈内动脉者术后生存率较低。12例未接受手术者中,2例死于颈内动脉破裂大出血,余10例追踪观察显示骨坏死范围均有不同程度扩大、加深和反复感染,1例颈内动脉裸露者随时有致死性大出血的可能。结论:新分型标准对病变的定位诊断更明确,在临床治疗中有指导意义。保守治疗对控制广泛性放射性颞骨骨坏死疗效不满意,而手术对控制、改善病情有显著疗效,患者生活质量明显提高。术后骨坏死仍有可能缓慢发展,因此术后对患者的长期追踪观察仍很有必要。Objective：To explore the effective treatment regimen for osteoradionecrosis of temporal bone.Method：Twenty-seven patients with massive osteoradionecrosis in temporal bone were included and retrospectively analyzed,in which,15 cases received surgery and the other 12 cases adopted non-surgical treatment.Result：In the surgery group,three cases died one year postoperatively and died of massive hemorrhage due to internal carotid blowout.One case died four years after surgery without clear cause of death,and two cases were lost to follow up.Out of the nine survivors,the follow up period ranged from four months to eight years（one was followed up eight years,one was followed up over four years,four were followed up two-three years,one was followed up over one year,one was followed up nine months,and one was followed up four months,respectively）.Patients classified as the type Ⅲ received best outcome,and patients of type Ⅴ and Ⅳ without invasion of the internal carotid artery received good surgical effects,while patients classified as the type Ⅳ with internal carotid artery invasion presented low survival rate.Two cases in the non-surgical group died of internal carotid rupture,and the other ten cases presented with repeated infection and expansion of the osteoradionecrosis lesion.Conclusion：The new classification criteria is helpful in diagnosis of location of lesions,and can serve as a guide for clinical therapy.Massive osteoradionecrosis in temporal bone responded unfavorably to conservative treatment,compared to that,surgery can effectively control the expansion of the lesion and markedly improve patient quality of life.Long-term follow up is necessary because of the slow development of osteoradionecrosis after surgey.

关 键 词：颞骨 放射性骨坏死 治疗 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]