鼻咽癌放疗后并发分泌性中耳炎的临床分析

Secretory Otitis Media after Radiotherapy for Nasopharyngeal Carcinoma

目的探讨鼻咽癌患者放射治疗后分泌性中耳炎的临床特点。方法对蚌埠医学院第一附属医院2007～2010年127例有完整资料鼻咽癌患者总结放疗后分泌性中耳炎的发生情况并分析其影响因素。结果 127例患者中放疗后116例发生分泌性中耳炎,分泌性中耳炎发生率为91.3%(116/127);放疗后3个月、6个月、12个月及18个月分泌性中耳炎的发生率分别为11.8%(15/127)、29.1%(37/127)、46.5%(59/127)及3.9%(5/127),差异有统计学意义(χ2=71.23,P<0.001)。中晚期患者(T3+T4)放疗后分泌性中耳炎发生率为96.2%(76/79),而早期患者(T1+T2)为83.3%(40/48),两者差异有统计学意义(χ2=4.73,P=0.030);鼻咽照射剂量≤70Gy的患者,放疗后分泌性中耳炎发生率为86.5%(64/74),当鼻咽照射剂量>70Gy的患者,分泌性中耳炎的发生率为98.1%(52/53),两者比较差异具有统计学意义(χ2=3.91,P=0.048);当咽鼓管咽口被侵犯后放疗后分泌性中耳炎发生率为98.2%(56/57),而未向咽鼓管咽口侵犯的鼻咽癌放疗后分泌性中耳炎的发生率为85.7%(60/70),两者比较差异具有统计学意义(χ2=4.75,P=0.029)。结论鼻咽癌患者放疗后分泌性中耳炎的发生率较高,在放疗后12个月达最高峰;咽鼓管咽口有无侵犯、鼻咽照射剂量和T分期与放疗后分泌性中耳炎的发生有关。

Objective This study was to study the incidence of secretory otitis media among patients with nasopharyn- geal carcinoma （NPC） after radiotherapy and potential influencing factors. Methods Clinical data of 127 NPC patients treat- ed at the First Affiliated Hospital of Bengbu Medical College from 2007 to 2010 were retrospectively analyzed. The incidence of secretory otitis media and possible contributing factors were assessed. Results Of the 116 NPC patients without secretory otitis media before radiotherapy, 91.3% （116/127） developed secretory otitis media after radiotherapy. The occurrence rates of secretory otitis media at 3, 6, 12 and 18 months after radiotherapy were 11.8% （15/127）, 29.1% （37/127）, 46.5% （59/127） and 3.9% （5/127）, respectively （χ2=71.23, P〈0.001）. The Incidence of SOM was higher among stage T3＋T4 patients （79 cas- es） than among stage T1＋T2 patients （48 cases）, （96.2% vs 83.3%, χ2=4.73, P=0.030）. The secretory otitis media was 86.5% （64/74） among patients who were given radiotherapy at 70-Gy or less, and 98.1% （52/53） among those whose radiation doses was more than 70-Gy （χ2=3.91, P=0.048）. The incidence of secretory otitis media in patients with pharyngeal orifice audito- ry tube infringement was 98.2% （56/57）, higher than in others （85.7%, 60/70） （χ2=4.75, P=0.029）. Conclusion The inci- dence of secretory otitis media in NPC patients after radiotherapy is high and reaches a peak in one year. It is influenced by invasion of pharyngeal orifice auditory tube, the dose of radiotherapy and T stage.