鼻咽癌放疗后颞骨放射性骨坏死的诊治

Diagnosis and treatment for osteoradionecrosis of temporal bone in nasopharyngeal carcinoma patients after radiotheraphy

目的总结鼻咽癌放射性颞骨坏死的临床资料,为今后的诊断和治疗提供经验。方法根据骨坏死的范围是否局限,分为局限性和广泛性的放射性颞骨坏死,对1995～2002年期间收治的13例鼻咽癌放射性颞骨坏死的患者进行回顾性分析,9例局限性骨坏死采用手术清除死骨8例,对症治疗1例;4例广泛性骨坏死采用手术治疗3例,保守治疗1例。结果9例局限性骨坏死,经手术一次性治愈7例,1例再次手术治愈;1例保守治疗,经历4年后死骨脱落,无新死骨形成;4例广泛性骨坏死除了保守治疗1例死于鼻咽大出血外,另3例经手术治愈。结论手术治疗是有效的治疗手段,广泛性的骨坏死可引起危及生命的并发症。

OBJECTIVE To provide reference for diagnosis and treatment of osteoradionecrosis of temporal bone in nasopharyngeal carcinoma patients by retrospective study. METHODS A total of 13 cases of osteoradionecrosis of temporal bone were retrospectively reviewed from 1995 to 2002, which were classified as local disease and diffuse disease based on extent of disease 8 cases of local disease and 3 cases of diffuse disease were treated by surgery, 1 case with local osteoradionecrosis and 1 case with diffuse osteoradionecrosis were treated by conservative methods. RESULTS Of the 9 cases of local disease, 7 cases were cured by operation and 1 case recovered after reoperations, 1 case was treated with conservative method . Of the 4 cases of diffuse disease,3 cases were cured by operations,1 case died of nasoparyngeal bleeding after conservative treatment.CONCLUSION Surgery is the best choice for osteoradionecresis of temporal bone and diffuse osteoradionecrosis may cause life-threatening complications.