鼻咽癌放疗后颞骨骨坏死的手术治疗

Surgical treatment of diffused 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有效治疗方法。方法对8例8耳鼻咽癌放疗后并发的颞骨放射性骨坏死行手术治疗:2耳行乳突根治术,1耳行扩大乳突根治术,5例采用乳突根治术+耳周带蒂组织瓣术腔填塞术。结果 8耳中共5耳(62.5%)获得干耳,无死骨再形成,2耳(25%)症状明显改善。其中行乳突根治+耳周带蒂软组织瓣术腔填塞术者获得干耳4耳,症状明显改善1耳,但术腔仍有感染及肉芽,均无死骨再形成;行乳突根治术者1耳获得干耳,另1耳术后半年游离死骨形成,再次手术切除,未能完全上皮化及干耳,需定期换药;扩大乳突根治术者1耳症状明显改善,但局灶性骨面暴露,未再见游离死骨形成。结论对鼻咽癌放射后颞骨放射性骨坏死治疗困难,手术治疗的主要目的是局部引流及预防并发症,采用乳突根治+耳周带蒂组织瓣术腔填塞是有效的治疗方法。

Objective To investigate the effective treatment method of osteoradionecrosis （ORN） of temporal bone in the patients with nasopharyngeal carcinoma （NPC）after radiotherapy. Methods Eight NPC patients （8 ears） with ORN of temporal bone accepted surgical treatment, 2 ears undergoing radical mastoidectomy, 1 ears undergoing extensive radical mastoidectomy, 5 ears undergoing radical mastoidectomy and obliteration with transferring local vascularized fascia flaps. Results Five of the 8 ears （ 62. 5% ） achieved dry ear, including 4 ears undergoing radical mastoidectomy and obliteration with vasculafized fascia flaps, and 1 ear undergoing radical mastoidectomy. Two of the 8 ears （25%） still had infection and were not fully epithelized ,but without sequestration, including 1 ear undergoing mastoidectomy and obliteration with vascularized fascia flaps, and 1 ear undergoing extensive radical mastoidectomy,One of the 8 ears（ 12. 5% ） which had received radical mastoidectomy needed revision surgery because of re-sequestration. Conclusion The surgical treatment for diffused ORN of temporal bone by radical mastoidectomy and obliteration with local vascularized flaps is effective. The main objective of the surgery is get excellent drainage and prevention of complications.