鼻咽癌放疗后颞骨放射性骨坏死的诊治

Diagnosis and treatment on osteoradionecrosis of temporal bone in cases with nasopharyngeal carcinoma after radiotherapy

目的:探讨鼻咽癌放疗后颞骨放射性骨坏死的诊断和治疗。方法:21例(22耳)鼻咽癌放疗后颞骨放射性骨坏死患者,经耳镜及影像学检查16例17耳局限型,5例5耳弥漫型。17耳局限型及1耳弥漫型予耳内镜下死骨刮除术,4耳弥漫型行乳突根治加耳周带蒂筋膜转移填塞术。结果:局限型17耳中,12耳(70.6%)创面完全上皮化,无游离死骨形成而治愈;4耳(23.5%)好转,创面未完全上皮化,但随访无死骨形成;1耳(5.9%)未愈,呈进行性死骨发展。弥漫型5耳中,1耳行有限度的死骨刮除术,创面完全上皮化而治愈;乳突根治4耳中,治愈3耳,1耳死骨形成再次手术,仍有耳漏。结论:耳内镜及颞骨CT为该病提供不同特点的诊断价值,对局限型行局部死骨刮除术能获得较好的疗效,提高患者的生活质量;弥漫型手术选择应慎重,本病有进行性缓慢发展的可能,需定期随访。

Objective：To discuss the diagnosis and treatment on osteoradionecrosis of temporal bone in cases with nasopharyngeal carcinoma （NPC）after radiotherapy. Method：The clinical data of 21 cases（22 ears）diagnosed as osteoradionecrosis of temporal bone with NPC were studied, including 17 ears of localized type and 5 ears of diffuse type. Minimally surgical debridement with otoscope was performed on 17 ears of localized type and 1 ear of diffuse type. Four ears of diffuse type underwent the modified radical mastoidectomy and obliteration with vascalarized fascia flaps. Result：The common clinical features were foul-smelling otorrhea and otalgia. Otoscopy revealed the exposed bone and bony sequestration in the external auditory canal with impacted keratotic debris, granulation tissue and cholesteatoma accumulation. It was with erosion or/and orifice to the mastoid. CT scan demonstrated the presentations：osteomyelitis, bone destruction as the islet-appearance and soft tissue mass. Among the 17 ears of localized type, 12 ears（70.6%） showed complete epithelization of the raw surface,4 ears（23.5%）not fully epithelized were followed up without sequestration, and 1 ear（5.9%） was developing progressively. As for the 5 ears of diffuse type, 1 ear received the minimally surgical debridement and another 3 ears treated with mastoidectomy and obliteration were healed. Only 1 ear needed secondary surgery because of re-sequestration. Conclusion：Both otoscopy and CT scan can offer the diagnostic value with different characteristics. The minimally surgical debridement of the sequestration by otoscopy can obtain good effects on localized type. It should be careful to select the surgery recipient on the diffuse type, and mastoid obliteration with vascularized flaps from regional tissue may be warranted after mastoidectomy. Regular follow up is needed because of possibility of the progressive development of the disease.