鼻咽癌放疗后张口困难的临床观察与分析

Radiation-Induced Temporomadibular Joint Lesion in Patients with Nasopharyngeal Carcinoma

目的 观察鼻咽癌患者放疗后张口困难情况 ,探讨影响放疗后张口困难的有关因素。方法 15 8例鼻咽癌患者中 32例用 8MV X线照射 ,5 5例用 6MV X线照射 ,71例用60 Coγ线照射 ,鼻咽原发病灶均采用面颈联合野常规分割照射 ,总剂量在DT( 6 5～ 80 )Gy总治疗时间 5 0～ 6 0天。以门齿距为观察张口困难的指标 ,用SOMA标准判定张口困难的程度。组间差异采用卡方检验。结果 全组张口困难发生率 2 4 .7% ,其中重度张口困难发生率为 0 .7%。放疗剂量为DT <70Gy、( 70～ 75 )Gy和 >75Gy的病人张口困难发生率分别为 11.2 %、2 6 .2 %和 4 0 .9% (P <0 .0 5 )。年龄 <4 6岁者和 >4 6岁者张口困难发生率分别为 17.8%和 31.7% (P <0 .0 5 )。坚持张口锻练者和未坚持张口锻练者张口困难发生率分别为2 0 .7%和 31.2 % (P <0 .0 5 )。结论 鼻咽癌放疗后张口困难是较常见的后遗症 ,一般发生在放疗后 3年内 ,重度张口困难发生率较低。颞颌关节和咀嚼肌群受照剂量、患者年龄和放疗后是否坚持张口锻练是主要影响因素。选用超高能X线 ( 15MV或 18MV)照射一定比例的剂量可以减少颞颌关节和咀嚼肌群受照剂量 ,可能是减少张口困难发生率的有效途径之一 。

Objective To observe radiation induced temporomandibular joint lesion in the patients with nasopharyngeal carcinoma and to evaluate its correlative factors.Methods From January 1999 to December 2000,158 patients with nasopharyngeal carcinoma received radical conventional radiotherapy .The total dose of the nasopharynx were (65～80)Gy and the overall treatment time were 50～60 days. It was evaluated the temporomadibular joint lesion by SOMA's criterion. The relationship of total doses, age of the patients, opening mouths practice and temporomandibular joint lesion was illustrated with curve estimation.Results The rate of temporomandibular joint lesion was 24.7% (39/158) in whole group. The rate of it in DT<70Gy, (70～75)Gy and >Gy were 11.2% , 26.2% and 40.9% , respectively ( P < 0.05 ). The rate was 17.8% and 31.7% , respectively at age of <46 and > ( P < 0.05 ). The rate of temporomandibular joint lesion was 20.7% and 31.2% , respectively, in the patients who insisted in opening mouths practices or not( P < 0.05 ).Conclusion Radiation induced temporomandibular joint lesion in radiation treated NPC patients was common. The total dose of nesopharynx, opening mouths practices and age are the three significant prognostic factors.