鼻咽癌放疗后脑损伤分析

Analysis of postirradiation cerebral lesion in nasopharyngeal carcinoma

目的探讨鼻咽癌放射治疗后脑损伤的临床特点、MRI表现、诊断、治疗、预后及相关因素。方法对30例鼻咽癌放射治疗后脑损伤患者进行回顾性分析,男19例,女11例。潜伏期为11～56个月,中位潜伏期37个月。MRI表现为T1WI低信号为主,T2WI均为高信号。结果26例早期用地塞米松及高压氧或舒氧灵治疗,全部病例症状体征有不同程度的改善。6例在出现神经症状8～42个月死亡,现生存24例,生存时间为1.0～8.0年。结论放射性脑损伤潜伏期短,症状重,治疗困难,预后差。建议设野时尽量减少脑组织照射剂量,以减少放射损伤的发生率。并强调早期诊断与重视治疗如激素、高压氧、扩张脑血管等治疗,必要时手术切除坏死灶,可达到改善鼻咽癌患者生存质量之目的。

To investigate the clinical characteristics, MRI manifestations, diagnosis, treatment, prognosis and relevant factors of postirradiation cerebral lesion in nasopharyngeal carcinoma. Methods Retrospective analysis 30 nasopharyngeal carcinoma cases who had postirradiation cerebral lesion, which include 10 male and 11 female. Their latent period is from 11 to 56 months and the median latent period is 37 months. TIWI mainly show low signals in MR1 while TEWI all show high signals.Results 26 cases treated with Dexamethasone and hyperbaric oxygen or Transfusion Use Asepsis Oxygen at early stage achieved different degree improvements in symptoms and signs. 6 cases died in 8 to 24 months after nerval symptoms occurred. Current survivors are 24. The survival time is 1 to 8 years. Conclusion The postirradiation cerebral lesion is serious although the latent period is short. The treatment is troublesome and its prognosis is bad. Minimizing cerebral radiation dose while planning and marking is suggested to result in reduction of radiation related lesion. The earliest diagnosis is significant as well as the treatment such as steroids, hyperbaric oxygen, cerebral vessels ectasia etc. The necrotic tissue may be removed by surgery at a pinch to result in improving the life quality of nasopharyngeal carcinoma patients.