鼻咽癌放疗后颅底放射性骨坏死的临床分析

Clinical Analysis on Osteoradionecrosis of Skull Base in Patients with Nasopharyngeal Carcinoma after Radiotherapy

目的：探讨鼻咽癌放疗后颅底放射性骨坏死（ｏｓｔｅｏｒａｄｉｏｎｅｃｒｏｓｉｓ ｏｆ ｔｈｅ ｓｋｕｌｌ ｂａｓｅ， ＯＲＮ）的临床特征，提高本病的诊断及治疗水平。方法：收集１２例确诊的鼻咽癌ＯＲＮ患者的病历资料，分析其临床表现、诊断、治疗及预后特点。结果：单程放疗者发生颅底ＯＲＮ的潜伏期为３年～１５年，而再程放疗者潜伏期为７月～２年。颅底ＯＲＮ特征性ＣＴ表现：骨破坏广泛而对称或局限；骨体的表面裸露在气腔中；有死骨形成；软组织见小气泡。内窥镜表现为鼻咽或耳道骨坏死，可见骨质裸露或死骨形成。而鼻咽复发者则不会看到这些表现。６例局限性ＯＲＮ手术治疗，１例死于衰竭；６例广泛性ＯＲＮ保守治疗，３例死于鼻咽大出血，１例死于衰竭。结论：颅底ＯＲＮ根据ＣＴ及内窥镜特征可诊断；手术治疗效果最佳。广泛ＯＲＮ或伴放射性颅神经损伤者预后较差，鼻咽大出血及衰竭为主要死因。

Objective: The current study was designed to investigate the diagnosis and the treatment of osteoradionecrosis of the skull base (ORN) in the patients with nasopharyngeal carcinoma (NPC) after radiotherapy. Methods: All patients (n=12) diagnosed as nasopharyneal carcinoma and osteoradionecrosis of the skull base were studied retrospectively with their clinical manifestations, diagnoses, therapies and prognoses. Result: ORN was found with characteristic CT and endoscopic findings, they were never seen in the patients with NPC relapse. The latent periods of ORN in the patients after primary radiotherapy were 3 - 15 years, while the periods were 7 months - 2 years in the patients after reirradiation. Six patients with local ORN were operated, 1 patients was died of exhaustion; Six patients with extensive ORN were heated using conservative methods, 3 patients were died of severe nasopharyngeal bleeding, while one were died of exhaustion. Conclusion: The ORN of the skull base after radiotherapy could be diagnosed by CT and endoscopic findings. The patients with extensive ORN or radiation-induced cranial neuropathy were associated with poor prognosis. The most common causes of death were severe nasopharyngeal bleeding and exhaustion.