鼻咽癌患者放疗后张口困难及其影响因素

Radiation-Induced Temporomandibular Joint Lesion in Patients with Nasopharyngeal Carcinoma

目的：观察鼻咽癌患者放疗后张口困难的情况，探讨影响放射性颞颌关节损伤的有关因素。方法：选择３５２例常规分割放疗结束后≥６个月的鼻咽癌病例，所有病例颞颌关节受照总剂量为５１．９０～７８．８９ Ｇｙ，总疗程３５～１４１天。以门齿距为观察张口困难的指标，组间差异采用卡方检验，张口困难发生率与颞颌关节受照剂量关系采用二元曲线拟合，多变量分析采用Ｌｏｇｉｓｔｉｃ回归。结果：全组张口困难发生率５８．５％，重度张口困难发生率７．１％；颞颌关节受照剂量为５１． ９０－６０． ００ Ｇｙ、＞ ６０． ００～７０． ００ Ｇｙ、＞ ７０． ００～７８． ８９ Ｇｙ的病人张口困难发生率分别为 ４６．４％、 ５３ ５％和 ６２． ３％（Ｐ＝０． ０５０）；放疗后坚持张口锻炼和未锻炼者发生率分别为５１． ６％和 ６１． ７％（Ｐ＝０．０２８）；年龄≤４２岁组和＞４２岁组发生率分别为５４．１％和６２．７５（Ｐ＝０．０４０）；颌关节受照剂量、张口锻炼与否和年龄大小是放射性颞颌关节损伤的独立影响因素。结论：鼻咽癌病人放疗后张口困难的发生率较高，颞颌关节受照剂量、张口锻炼和病人年龄是主要的影响因素。鼻咽靶区全部剂量都从两颞侧给予的照射方式应设法予以改进。

Objective: The aim of this study was to evaluate radiation-induced temporomandibular joint damage in the patients with nasopharyngeal carcinoma, and its correlative factors were analyzed. Methods: From November 7, 1966 to July 2, 1999, 352 patients with nasopharyngeal carcinoma received radical conventional radiotherapy were eligible for this analysis. The total dose of the temporomandibular joint were 51. 90 - 78. 89 gray and the overall treatment time were 35- 141 days. The endpoint was the distance between two dens incisivus medians (DDIM). The relationship between total doses and temporomandibular joint lesion was illustrated with curve estimation. Multivariate analysis with logistic Regress was performed to evaluate the significance of prognostic variables on temporomandibular joint lesion. Results: The patient of DDIM < 3 cm in whole group was 58. 5%; the DDIM (1 cm rate was 7. l%; the DDIM < 3 cm rate in the patients with temporomandibular joint doses 51. 90 - 60. 00 gray, > 60. 00 - 70. 00 gray, and > 70. 00 - 78. 89 gray were 46. 4%, 53. 5%, and 62. 3% , respectively (P = 0. 050); and in the patients who insisted in opening mouths practice or not were 51. 6% and 61. 7% respectively (P = 0. 028 ); and in patients at age of 18 - 42 and 43 - 71 were 54. l% and 62. 7% respectively (P = 0. 040 ). They were all significant prognostic factors for radiation-induced temporomandibular joint lesion. Conclusion: Radiation-induced temporomandibular joint lesion in radiation treated NPC patients was serious. The total dose of temporomandibular joint, opening mouths practice and age are three significant prognostic factors.