鼻咽癌放射治疗后鼻咽坏死60例临床分析  

Clinical analysis of 60 cases with radiative nasopharyngeal necrosis in nasopharyngeal carcinoma

作　　者：吴君心[1] 徐鹭英[1] 杨百华[1] 林少俊[1] 张春[1] 林冯杰[1] 郭歹于娟 韩露[1] 潘建基[1] 

机构地区：[1]福建医科大学福建省肿瘤医院放疗科,福州350014

出　　处：《中华耳鼻咽喉头颈外科杂志》2012年第3期185-190,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨鼻咽癌放射治疗后鼻咽坏死的临床特点、诊断、治疗、预后及相关因素。方法对60例诊断明确的鼻咽癌放疗后发生鼻咽坏死患者进行回顾性分析，男50例，女10例，年龄30—70岁，中位年龄51．5岁。所有患者均行纤维鼻咽镜下鼻咽坏死清创术，感染者配合全身或局部抗感染治疗。Kruskal-WallisH检验分析鼻咽坏死发生距末次放射治疗结束的时间（放疗一坏死间隔时间）及治疗后疗效的相关因素；Cox比例风险回归模型评价预后风险因素。结果放疗．坏死间隔时间为1～156个月，中位时间5个月；一程放疗组及多程（≥2）放疗组的放疗一坏死间隔中位时间分别为7．0和4．5个月，差异有统计学意义（X^2=5．527，P=0．031）；T2组和≥T3组的中位放疗一坏死间隔时间分别为7．5和5．0个月，差异有统计学意义（X^2=4．330，P=0．037）。鼻咽伴有感染者41例（68．3％），感染和未感染患者疗效差异有统计学意义（X^2=14．775，P〈0．001）。经纤维鼻咽镜下鼻咽清创术及全身或局部抗感染治疗后，全组患者症状均有不同程度缓解。随访2-46个月，中位数12．5个月，7例死于鼻咽大出血，15例死于肿瘤或系统衰竭，5例失访，其他均存活。Cox回归分析显示颈内动脉受侵显露是影响患者预后的独立危险因素（P〈0．05）。结论纤维鼻咽镜下鼻咽坏死清创术为一种有效的治疗手段，感染对鼻咽坏死的发生及疗效均有影响；放疗剂量、疗程及肿瘤分期是放疗后鼻咽坏死形成的重要因素，鼻咽坏死灶累及颈内动脉是影响预后的独立危险因素，鼻咽大出血及衰竭为主要死因。Objective To study the clinical characteristics, diagnosis, treatment and prognostic factors of patients with postradiation nasopharyngeal necrosis（PRNN） in nasopharyngeal carcinoma（NPC）. Methods Sixty patients with PRNN were studied retrospectively, 50 males and 10 females, age ranging from 30 - 70 years of （ median 51.5 years）. All patients were treated with endoscopic debridement and systemic or local anti-inflammatory treatment. Kruskal-Wallis H test was used to assess the interval time between irradiation completion and necrosis onset and related factors of treatment outcome. Multivariate Cox proportional hazards regression survival analysis was performed to analyze risk factors. Results The latent period between the last irradiation and the onset of the symptom ranged from 1 to 156 months, with a median of 5 months. The median interval time was 7.0 months in 1 course group and 4.5 months in I〉 2 courses group （ X2 = 5. 527,P = 0.031 ） , and 7.5 months in T2 group and 5.0 months in I〉 T3 group （ X2 ~ 4.330, P = 0. 037 ）, respectively. Forty-one patients of them had nasopharyngeal infection, and the difference in curative effect between infection group and non-infection group was significantly（ X2 = 14. 775 ,P 〈 0. 001 ）. Symptoms were alleviated in all patients after endoscopic debridement and systemic or local anti-inflammatory treatment. Follow-up for all patients ranged from 2 to 46 months （ median 12.5 months）. Seven patients with internal carotid artery exposure died of sudden nasopharyngeal massive bleeding and fifteen patients died of tumor or systemic exhaustion; five cases were lost, and the rest were all in survival. Inter carotid artery erosion was an independent prognostic risk factor according to multivariate Cox proportional hazards regression survival analysis （ P 〈 0.05 ）. Conclusions Endoscopic debridement is effective in treating irradiation-related nasopharyngeal necrosis. The occurrence of nasopharyngeal necrosis is related toinfection,irradiation �

关 键 词：鼻咽肿瘤 放射疗法 坏死 出血 

分 类 号：R739.63[医药卫生—肿瘤]