放射性臂丛神经损伤的研究现状

Recent progress on research of radiation-induced brachial plexus injury

放射性臂丛神经损伤(RIBRI)是指患者在放射治疗过程中,臂丛神经受高剂量或是单次大剂量照射后引起的臂丛神经功能障碍。发病机制尚不十分明确,放射性纤维化发挥了重要作用。致病因素主要为放射因素、联合治疗、个体差异等,导致患者发病情况不一。RIBRI潜伏期为数月或数年,初期主要表现为上肢主观感觉异常或神经性疼痛,随着病变进展,逐渐发展为整个上肢感觉减退、麻痹无力、甚至瘫痪,神经性疼痛发生较少。该病可以通过患者的放射治疗史、无症状间歇期、临床特点、查体、MRI、肌电图等检查明确诊断,需注意与肿瘤转移或放射诱导性肿瘤相鉴别。RIBRI是一种不可逆性疾病,目前尚无根治方法,重在预防,药物、手术等治疗起到一定缓解作用。

Radiation-induced brachial plexus injury （RIBPI） is a functional disorder of the brachial plexus （BP）, caused by higher total radiation dose or higher single dose to the BP during radiation therapy （RT）.The etiol-ogy involved in the development of RIBPI includes RT , combined treatment modalities , and individual susceptibility . Its latent may vary largely , from a few months to several years .Initial symptom may be subjective paresthesia or neu-ropathic pain in the upper extremities .Subsequently , the patients may suffer from hypesthesia in the upper extremi-ties, weakness, or even paralysis.The diagnosis of RIBPI is based on history of RT, interval with no symptom, clini-cal manifestation , physical exam , magnetic resonance imaging （ MRI ） , and electromyogram .Differential diagnosis should exclude metastasis from malignant disease or radiation-induced second malignance .It is believed that the RIB-PI is a progressive process which may eventually result in devastating functional consequences , and no effective mo-dality is available to treat this disease so far .Medication and surgery only play a palliative role in this disease .There-fore, methods for preventing BP injury before its onset appear particularly crucial .