中西医结合防治鼻咽癌患者放射性张口困难的临床观察与护理

The clinical study of in tear anted trade tic anal and western medicine preventing difficulty in opening mouth caused by radiotherapy for patients of nasopharyngeal carcinoma.

目的鼻咽癌由于其解剖和病理学的特点，首选根治性放射治疗，但因放射剂量大（一般DT〉70Gy），放疗时间长（7wk以上），易使颞颌关节及咀嚼肌发生退行性变和纤维化、肌肉萎缩、关节硬化而引起张口困难严重影响患者的生活质量，甚至致残；部分患者被迫中断放疗。因此探讨早期康复训练对鼻咽癌患者接受根治性放射治疗后张口困难的防治效果。方法将26例鼻咽癌放射治疗患者随机分为观察组和对照组各63例。观察组在放疗的同时采取早期穴位注射复合液及康复训练。对照组单纯接受鼻咽癌放射治疗。在放射治疗后，及治疗半年，一年半后分别对两组患者的门齿间距进行测量。结果观察组患者放疗后张口缩小的发生率为12．7％。其程度明显低于对照组为30、7％。半年后观察组为9．5％，对照组为47．6％，一年半后观察组为7．9％，对照组为49．2％（P〈0．01）。结论中西医结合（早期穴位药物注射，同时配合康复训练），有助于降低鼻咽癌患者放射治疗后张口困难的发病率，提高患者的生存质量。

Objective Acceding to the anatomical and pathological characteristic of nasopharyngeal carcinoma, radical radiotherapy was chooser first. 5years liveability rate was about 50%. But because radiation dose was big[ normally DT 〉 70Gy] and radiation time was long [ 〉 7wk], temporomandibular joint and master became retrograde affection and fibrosis, so these resulted in difficulty in opening mouth and influenced badly existence quantity of patients, so much as deformity, part of them yielded up radiotherapy. We explore the efficacy of rehabilitation training to preventing difficulty in opening mouth caused by radiotherapy for nasopharyngeai carcinoma patients. Methods 126 cases were at random divided into the study group （63cases） and the control group （63cases）. In the course of radiation therapy, the study group＇s patients talked recovery training. And point - injection the control group＇s patients were only treated with radiation therapy after therapy, half a year later and 1.5 - year later, both groups＇s distance between up and down incisor teeth was measured respectively. Results The occurrence rates of difficulty in opening mouth in the study group were respectively 12.7% （ after therapy） , 9.5% （ half a year later） ,7.9% （ 1.5- year later）, The control group＇s were turn in 39.7% ,47.6%, 49.2%. There was markedly difference between both groups （ P 〈 0.01 ）. Conclusions （ Integrated traditional and western medicine together with rehabilitation training） Redound to reducing the occurrence rate of difficulty in opening mouth caused by radiation therapy for patients of nasopharyngeal carcinoma, and it could enhance existence quantity of the patients.