放射性鼻咽颅底骨坏死的S-B分期探讨  

S-B Classification for Radionecrosis of Nasopharynx and Skull Base

作　　者：汤轶强[1] 敖帆[1] 黄敏[1] 谢建国[1] 龚晓昌[1] 万桂芬[1] 李金高[1] TANG Yiqiang;AO Fan;HUANG Min(Jiangxi Cancer Hospital,Nanchang,330029)

机构地区：[1]江西省肿瘤医院,330029

出　　处：《实用癌症杂志》2020年第4期561-565,共5页The Practical Journal of Cancer

基　　金：国家癌症中心攀登基金(编号:NCC201814B039);江西省卫计委课题(编号:20161107)。

摘　　要：目的探讨建立放射性鼻咽颅底骨坏死S(soft tissue,软组织)-B(bone,骨质)分期方法。方法回顾性分析鼻咽癌放疗后发生放射性鼻咽颅底骨坏死的患者,对其纤维鼻咽镜和鼻咽磁共振图像进行动态比较。根据纤维鼻咽镜中溃疡深度及骨质是否暴露进行S分期,根据鼻咽磁共振中颅底骨新增病变区域的图像改变进行B分期,结合S、B分期进行综合分为3期。结果45例放射性鼻咽颅底骨坏死病例纳入研究,可以观察到S1→S2→S3以及B1→B2→B3逐级进展的动态过程。综合分期Ⅰ期死亡率10%(1/10),Ⅱ期死亡率0(0/14),Ⅲ期死亡率42.9%(9/21),差异有统计学意义(P<0.001)。Ⅱ期患者进展为Ⅲ期的可能性高于Ⅰ期(44.0%vs.23.3%),差异接近统计学意义(P=0.08)。结论放射性鼻咽颅底骨坏死存在软组织病变和骨质病变逐级进展的动态过程,通过新的S-B分期方法可以标示其发展阶段。各分期预后不同。Objective To introduce a novel clinical classification for radionecrosis of nasopharynx and skull base(RNNSB)through a retrospective analysis.Methods Retrospective analysis of nasopharyngeal carcinoma patients with RNNSB was carried out.Pictures of fiberoptic endoscopic examination and magnetic resonance image were collected and dynamic compared for each patient.S stage is classified according to ulceration depth and bone exposure in fiberoptic endoscopic examination.B stage is classified according to magnetic resonance image.Combined with S and B stages,RNNSB is divided into S-B stages.Results 45 cases of RNNSB were included in this study.The mortality rate in the stageⅠ,Ⅱ and Ⅲ was 10%(1/10),0(0/14)and 42.9%(9/21),respectively(P<0.001).Patients in phase Ⅱ were more likely to progress to phase Ⅲ than ones in phase Ⅰ(44.0%vs.23.3%),the difference was close to statistical significance(P=0.08).Conclusion There is a dynamic progression of soft tissue lesions and bone lesions in RNNSB,which can be distinguished by the new S-B classification.The prognosis of each stage is different.

关 键 词：鼻咽颅底骨坏死 S-B分期 鼻咽癌 

分 类 号：R739.62[医药卫生—肿瘤]