鼻咽癌放疗后放射性鼻窦炎的影响因素及治疗效果探讨

Radiation nasosinusitis after radiotherapy for nasopharyngeal carcinoma:risk factors,clinical features and treatment

目的分析鼻咽癌患者放疗后发生鼻窦炎的影响因素及临床特点,并探讨放疗后继发鼻窦炎的预防、治疗措施和手段。方法回顾性评价86例鼻咽癌患者放疗前后头颈部CT或MRI检查资料,结合其中15例患者放疗后的鼻内镜检查资料,对鼻咽癌患者放疗后发生鼻窦炎的影响因素及部分患者的治疗效果进行统计学分析。结果 86例鼻咽癌患者中,放疗前16例患有鼻窦炎,放疗后55例发生鼻窦炎,其中T分期较高、鼻腔有侵犯的患者放疗后鼻窦炎发生率较高(P=0.003和P=0.024)。放疗中及放疗后给予鼻腔冲洗等局部治疗的患者鼻窦炎发生率较低(P=0.000),放疗前就有鼻窦炎的患者,11例放疗后未得到改善,CT显示仅4例患者鼻窦炎好转,治疗前后比较差异无统计学意义(P>0.05),6例甚至有所加重。18例长期应用鼻血管收缩剂滴鼻(连续使用>1月)引起药物性鼻炎,鼻阻塞、鼻窦炎症状更加严重。结论鼻咽癌患者放疗后鼻窦炎发病率高,T分期较高、鼻腔有侵犯、鼻腔冲洗等局部治疗是放疗后继发鼻窦炎可能的影响因素,加强放疗中、后期鼻腔局部治疗可减少放疗后鼻窦炎的发生。

Objective To analyze the risk factors, clinical features and treatment of radiation nasosinusitis after radiotherapy in patients with nasopharyngeal carcinoma （NPC）. Methods The clinical data and CT, MRI, nasal endoscopic findings of 86 patients with NPC before and after radiotherapy were retrospectively analyzed. Results Among 86 cases, there were 16 cases with nasosinusitis before radiotherapy and 55 cases after. Patients with high T stage and nasal cavity involved had a higber rate of radiation nasosinusitis （P = 0. 003 and P = 0. 024, respectively）, and those with nasal rinse treatment during and after radiotherapy had a lower rate of radiation nasosinusitis （ P = 0. 000 ）. Eleven patients with nasosinusitis before radiotherapy did not get better after radiotherapy, 6 of them even worse. Eighteen patients with drug- induced rhinitis by long-term administration of nasal vasoconstrictors had nasal obstruction and more serious nasosinusitis. Conclusion Patients with nasopharyngeal earcinoma have a high rate of radiation nasosinusitis after radiotherapy, and nasal topical treatment during and after radiotherapy may attenuate radiation nasosinusitis.