鼻咽癌放疗致鼻窦炎的影响因素分析及鼻内镜手术处理疗效观察

Influence factors analysis of radiation nasosinusitis in nasopharyngeal carcinoma patients and therapeutic effect of endoscopic surgery

目的探讨鼻咽癌放疗致鼻窦炎的特点、影响因素及鼻内镜手术处理疗效。方法回顾性分析2006年11月~2010年6月就诊的经活检病理确诊为鼻咽癌并接受全程根治性放射治疗的9 6例患者的临床资料,观察鼻咽癌放疗致鼻窦炎的特点,并采用单因素和多因素分析放射性鼻窦炎的影响因素,同时对放射性鼻窦炎患者行鼻内镜手术,观察其手术疗效。结果放疗随访半年后,总的鼻窦炎发生率83.33%（80/96）,明显高于放疗前鼻窦炎发生率54.17%（52/96）,经比较两者具有统计学意义（χ2=2 3.7 3 6,P〈0.05）。放疗后单发性鼻窦炎和多发性鼻窦炎发生率分别3 0.2 1%和53.13%。各鼻窦的放射性鼻窦炎发生率从高到底依次为上颌窦炎、筛窦炎、蝶窦炎和额窦炎（χ2=68.871,P〈0.05）。单因素分析筛选出T分级、鼻腔侵犯和鼻咽冲洗3个因素可能与放射性鼻窦炎有关,多因素分析发现T分级和鼻咽冲洗是放射性鼻窦炎的独立影响因素。32例放射性鼻窦炎患者接受鼻内镜处理后随访1年,其中治愈18例（56.2%）,好转10例（31.3%）,无效4例（12.5%）,总的有效率为87.5%。结论鼻咽癌患者放疗后及时进行鼻咽冲洗可以有效减少放射性鼻窦炎的发生,鼻内镜手术处理放射性鼻窦炎疗效显著。

Objective To investigate the characteristics, influence factors of radiation nasosinusitis （RNS） and therapeutic effect with endoscopic surgery in nasopharyngeal carcinoma （ NPC ） patients. Methods Clinical data of 96 patients pathologically diagnosed as NPC and received radiotherapy from Nov 2006 to June 2010 in our hospital （was） analyzed retrospectively. The characteristics of RNS were observed, univariate and msultivariate analyses were adopted to investigate its influence factors and therapeutic effect with endoscopic surgery. Results The overall incidence of sinusitis six months after radiotherapy was 83. 33 % , which was significantly higher than that before radiotherapy （54. 17% ） （X2 = 23. 736, P 〈0.05 ）. After radiotherapy, the incidence rates of single sinusitis and multiple sinusitis were 30.21% and 53. 13 % respectively. The incidence rate of RNS decreased in maxillary sinus, ethmoid sinus, sphenoid sinus and frontal sinus in regular order （X2 = 68. 871 , P 〈 0. 05 ）. Univariate analysis showed T stage, invasion of nasal cavity and nasopharyngeal irrigation might be related with RNS. Multivariate analysis showed that T stage and nasopharyngeal irrigation were the independent factors for RNS. 32 RND patients received endoscopic surgery. Of them, 18 were cured （ 56.2% ） , 10 （ 31. 3% ） showed improved, 4 cases （ 12. 5% ） were invalid with a total effective rate of 87. 5%. Conclusion Nasopharyngeal irrigation can effectively reduce the incidence rate of RNS in NPC patients after radiotherapy. Endoscopic surgery can achieve significant effect for RNS.