个性化口腔定位支架在调强放疗中的应用效果评价  

Effects of personalized oral stents in intensity-modulated radiation therapy treatment

作　　者：叶红飞 王佩露 孟洁琼 孙方方[2] YE Hong-fei;WANG Pei-lu;MENG Jie-qiong;SUN Fang-fang(Department of Stomatology,Nanjing Gaochun People's Hospital.Nanjing 211300;Department of Stomatology,Nanjing Stomatological Hospital.Nanjing 210008,Jiangsu Province,China)

机构地区：[1]南京市高淳人民医院口腔科,江苏南京211300 [2]南京市口腔医院口腔科,江苏南京210008

出　　处：《上海口腔医学》2024年第5期533-537,共5页Shanghai Journal of Stomatology

基　　金：江苏省医学科研重点项目(K2023043);江苏卫生健康职业学院院级科研项目(JKC202008)。

摘　　要：目的:探讨个性化口腔定位支架在调强放疗(intensity-modulated radiation therapy,IMRT)中的应用效果。方法:选择2021年1月—2023年12月在南京市高淳人民医院接受IMRT治疗的108例鼻咽癌患者。利用随机数字表法将患者分为使用个性化口腔定位支架的试验组(54例)和使用简易口塞的对照组(54例)。比较2组临床靶区(clinical target volumes,CTV)与口腔正常组织的受照剂量、适形指数(conformity index,CI)、均匀性指数(homogeneity index,HI)、模拟视觉量表(visual analogue scale,VAS)测定的疼痛程度、口腔黏膜炎分级、口干评分、味觉评分、口腔健康影响量表(oral health impact profile,OHIP)评分及并发症(龋病、口干症、味觉障碍、口腔念珠菌病和颌骨骨髓炎)发生情况。采用SPSS 23.0软件包对数据进行统计学分析。结果:2组CTV、舌体上的平均受照剂量和CI、HI值相比无显著差异(P>0.05);试验组在下颌骨、下颌牙、双侧腮腺上的平均受照剂量显著低于对照组(P<0.05)。治疗后,VAS、口腔黏膜炎等级、口干程度、OHIP和并发症方面,试验组显著低于对照组(P<0.05)。试验组味觉评分显著高于对照组(P<0.05)。结论:个性化口腔定位支架在IMRT治疗中可显著降低口腔部位的受照剂量,减少疼痛和其他并发症,改善患者生活质量。PURPOSE:To explore the effects of personalized oral stents in intensity-modulated radiation therapy(IMRT)treatment.METHODS:Totally 108 patients with nasopharyngeal carcinoma treated with IMRT at Nanjing Gaochun People's Hospital from January 2021 to December 2023 were selected.Using a random number table method,the patients were divided into experimental group(n=54)using personalized oral stents and control group(n=54)using simple mouthpieces.The dosimetry of clinical target volumes(CTV),normal oral tissues,conformity index(CI),homogeneity index(HI),pain level evaluated by visual analogue scale(VAS),grades of oral mucositis,xerostomia scores,taste scores,oral health impact profile(OHIP)scores and incidence of complications(dental caries,xerostomia,taste disorders,oral candidiasis,osteomyelitis of the jaw)were compared between the two groups.SPSS 23.0 software package was used for statistical analysis.RESULTS:There was no significant difference between the two groups in average received dose and CI,HI values on CTV and the tongue(P>0.05);however,the experimental group showed a lower average received dose on the mandible,mandibular teeth,and bilateral parotid glands compared to the control group(P<0.05).After treatment,the experimental group had significantly lower scores in VAS,grades of oral mucositis,xerostomia evaluation,OHIP and frequency of complications(P<0.05).The taste scores in the experimental group were significantly higher than that in the control group(P<0.05).CONCLUSIONS:Personalized oral stents significantly reduce the radiation dose to oral sites in IMRT treatment,decrease pain and other oral complications,and improve patients'quality of life.

关 键 词：个性化口腔定位支架 调强放疗 口腔并发症 受照剂量 

分 类 号：R739.8[医药卫生—肿瘤]