鼻咽癌放疗后腭咽功能障碍的诊治

Velopharyngeal insufficiency following radiotherapy in patients with nasopharyngeal carcinoma

目的 探讨鼻咽癌放疗后腭咽功能障碍的可能原因及诊治措施。方珐对16例鼻咽癌放疗后出现腭咽功能障碍患者（14例软腭功能障碍，2例软腭功能障碍合并硬腭穿孔）的临床诊断与处理资料行回顾性分析。结果本组病例放疗量为68～75Gy，平均放疗量70Gy，疗程2个月；腭咽功能障碍均在放疗5年后出现症状，平均发病为放疗后8．3年，2例合并硬腭穿孔者的发病都在放疗10年后出现。开放性鼻音、进食经鼻反流是腭咽功能障碍的主要症状，经体位压力进食法、带腭护板及经常性的鼻腔清洗治疗，症状可得到缓解。结论鼻咽癌放疗后腭咽功能障碍的发展缓慢，在常规放疗根治量范围内，放疗量并非主要的原因，个体的差异可能更重要；硬腭穿孔是慢性缺血性骨坏死的结果。根据患者的情况采取适当的治疗措施可以缓解症状，提高生活质量。

Objective To explore the possible reasons, diagnosis and treatment of velopharyngeal insufficiency in patients with nasopharyngeal carcinoma （NPC） after radiotherapy. Method 16 cases of velopharyngeal insufficiency including 14 cases of soft palate dysfunction and 2 cases of soft palate dysfunction with hard palate perforation were retrospectively analyzed. Results The radiotherapy dose of this group was from 68 to 75 Gy and an average of 70 Gy. Velopharyngeal insufficiency occurred within 5 years after radiotherapy and an average of 8.3 years, and it mainly had open rhinolalia and transnasal-reflux. Position-pressure eating, palate back-plate use and nasal cavity irrigation relieved the symptoms. Conclusion Velopharyngeal insufficiency slowly develops in patients with NPC after radiotherapy. With a routine dose, radiotherapy is not the key factor for velopharyngeal insufficiency, moreover individual differences may be more important. Hard palate perforation may be the result of chronic ischemic, and it may be relieved by suitable treatments.