鼻咽癌放疗后继发慢性鼻窦炎的临床特征

Clinical characters of chronic sinusitis induced by radiotherapy for nasopharygeal carcinoma

目的分析鼻咽癌放疗后继发慢性鼻窦炎的临床特征。方法对2011年1月至2013年5月来我科门诊及住院治疗的放疗致慢性鼻窦炎患者(放疗组)及单纯慢性鼻窦炎患者(对照组)各40例行视觉模拟评分法(VAS)评价鼻部主观症状、鼻内镜检查、鼻窦CT检查,并给予相应评分。放疗组中15例及对照组中36例接受鼻内镜鼻窦手术,术中行上颌窦穿刺,抽取脓性分泌物行细菌培养。结果 VAS评分:放疗组为鼻塞4.0±0.8,流脓涕6.5±1.2,头痛4.3±0.6,嗅觉减退5.1±1.4,咳嗽2.7±1.2,打喷嚏3.7±0.8,面部疼痛和压迫感4.3±1.2,耳痛5.3±1.1;对照组为鼻塞4.3±0.7,流脓涕5.3±1.0,头痛3.3±0.8,嗅觉减退4.0±0.9,咳嗽3.3±1.0,打喷嚏3.7±0.9,面部疼痛和压迫感2.2±0.5;其中流脓涕、耳痛症状放疗组较对照组明显;鼻窦CT Lund-Mackay评分:放疗组为8.2±1.1,对照组为6.5±1.3;鼻内镜Lund-Kenndy评分:放疗组为6.2±1.1,对照组为4.7±0.7;上颌窦分泌物细菌培养结果:放疗组以金黄色葡萄球菌(6/15)、流感嗜血杆菌(3/15)为主,还有部分未查到细菌生长(4/15);对照组以金黄色葡萄球菌(24/36)、流感嗜血杆菌(6/36)、草绿色链球菌(5/36)为主。结论放疗致鼻窦炎较单纯慢性鼻窦炎有其自身特点,其发生机制可能与放射损伤鼻窦纤毛功能,窦口肿胀、阻塞,继发细菌感染有关。

Objective To investigate the characters of chronic sinusitis induced by radiotherapy for nasopharyngeal car-cinoma.Methods The clinical data of 40 chronic sinusitis patients induced by radiotherapy for nasopharyngeal carcino-ma （the radiotherapy group）and 40 common chronic sinusitis patients （the control group）enrolled in our department from January 2011 to May 2013 were retrospectively analyzed.All patients were measured the symptom visual analysis scale （VAS）and took endoscopic examination and sinus CT scanning.A total of 18 patients of the radiotherapy group and 36 patients of the control group accepted endoscopic surgery,during the operation,purulent secretion in the maxil-lary was exacted and bacterial culture was done.Results As to the VAS,nasal secretion was significantly more severe in the experimental group （6.5 ±1.2）in comparison with the control group （5.3 ±1.0,P 〈0.05）.As to the endo-scopic finding,more dry and more curst in the postior nasal cavity and nasopharynx,the Lund-Kenndy score was 6.2 ± 1.1 in the experimental group vs 4.7 ±0.7 in the control group.The main reasons laid in high CT scores and high involved rates of ostiomeatal complex,frontal sinus,maxillary sinus and anterior ethmoid sinus.Conclusion The characters of chronic rhinosinusitis caused by radiotherapy are quite different from those of the common chronic sinusi-tis.The mechanism of chronic sinusitis induced by radiotherapy prefers to obstruction of the ostium or dysfunction of the cilia continued with bacterial infection.