鼻咽癌放射治疗后继发慢性鼻-鼻窦炎的临床特征分析

Analysis of clinical characters of chronic rhinosinusitis in patients with postirradiated nasopharyngeal carcinoma

目的研究鼻咽癌放射治疗后继发慢性鼻-鼻窦炎的特征。方法对65例鼻咽癌放疗后继发慢性鼻-鼻窦炎和65例成人慢性鼻-鼻窦炎（对照组）患者分别进行主观症状视觉模拟量表（visual analogue scale，VAS）评分，鼻内镜检查和鼻窦CT检查，并以Lund—Mackay评分法记录CT分值。结果鼻咽癌放疗后继发慢性鼻-鼻窦炎组鼻分泌物鼻后滴漏VAS评分为（7．86±1．62）分，与对照组的（5．12±1．32）分相比，差异有统计学意义（t=10．541，P〈0．01）；鼻咽癌放疗后继发慢性鼻．鼻窦炎组鼻内镜下中鼻道清洁者占53．8％，与对照组（35．4％）相比，差异有统计学意义（X2=4．483，P〈0．05）；鼻咽癌放疗后继发慢性鼻-鼻窦炎组鼻窦CT的Lund—Mackay评分为（7．03±4．63）分，显著低于对照组的（11．42±3．32）分，差异有统计学意义（t=-6．207，P〈0．05），主要原因在于窦口鼻道复合体、额窦、上颌窦、前筛的Lund—Mackay评分、累及率均显著低于对照组。结论鼻咽癌放疗后继发慢性鼻-鼻窦炎病变程度较轻，病变特征与-般慢性鼻-鼻窦炎不同，应采取不同的治疗策略。

Objective To study the characters of chronic rhinosinusitis in patients with irradiated nasopharyngeal carcinoma. Methods There were 65 cases of chronic rhinosinusitis after irradiated nasopharyngeal carcinoma （NPC, experimental group） and 65 cases of common chronic rhinosinusitis （CRS, control group） in the study. The visual analogue scale （VAS） was used to evaluate the intensity of subjective symptoms. Endoscopic finding was recorded and CT results were evaluated by Lund-Mackay scoring system. Results As to the VAS, nasal secretion was significantly more severe in experimental group （7. 86 ± 1.62）, compared with control group （ 5. 12± 1.32, t = 10. 541, P 〈 0. 01 ）. As to endoscopic finding, middle nasal meatus were clean in 35 （53.8%） cases in experimental group, and 23 cases （35.4%） in control group（ X2 = 4. 483, P 〈 0. 05 ）. CT score was （7. 03 ± 4. 63 ）in experiment group, and （ 11.42 ± 3.32） in control group （ t = - 6. 207, P 〈 0. 05 ）. The main reason lays in lower CT score and lower involved rate of ostiomeatal complex, frontal sinus, maxillary sinus, anterior ethmoid sinus. Conclusions The characters of chronic rhinosinusitis in patients with irradiated nasopharyngeal carcinoma is quite different from the common CRS and different therapeutic measures should be taken.