鼻咽癌放疗致鼻窦炎患者采用鼻内镜手术处理的临床疗效

Characteristics and influence factors of sinusitis in nasopharyngeal carcinoma underwent radiation and therapeutic effect of endoscopic surgery

目的分析鼻咽癌放疗后鼻窦炎的临床特点和影响因素,探讨鼻内镜下手术治疗鼻咽癌放疗后鼻窦炎的临床效果。方法选取2003年3月至2013年12月间广元市中心医院收治的经活检病理确诊并接受放疗的150例鼻咽癌患者的临床资料,观察鼻咽癌放疗后鼻窦炎的临床特点,分析鼻咽癌放疗后发生鼻窦炎的影响因素,以临床表现、鼻窦计算机断层扫描改善情况评价鼻内镜手术治疗的临床疗效。结果放疗后随访12个月,鼻窦炎的发病率为82.0%,高于放疗前的发病率(47.3%),差异有统计学意义(P<0.05);其临床特点主要为流脓涕、嗅觉减退等。单因素分析显示,放疗后鼻窦炎与肿瘤分期、鼻腔侵犯、年龄、病理类型等因素有关。多因素Logistic分析显示,肿瘤分期和鼻腔侵犯是放疗后鼻窦炎的独立影响因素。76例鼻咽癌放疗后鼻窦炎患者接受鼻内镜手术治疗,术后随访6个月,治愈41例(53.9%),好转26例(34.2%),无效9例(11.8%),总有效率为88.2%。结论鼻咽癌放疗后鼻窦炎的发生率较高,主要与肿瘤分期、鼻腔侵犯等因素有关,行鼻咽冲洗可以有效减少鼻窦炎的发生,鼻内镜手术治疗鼻咽癌放疗后鼻窦炎临床疗效确切,是治疗鼻咽癌放疗后鼻窦炎有效的方法。

Objective To analyze the characteristics and influence factors of sinusitis in nasopha- ryngeal carcinoma underwent radiation and therapeutic effect of endoscopic surgery. Methods From March 2003 to December 2013, pathological diagnosis and clinical data of 150 cases of patients with nasopharynge- al carcinoma radiotherapy were selected, and the characteristics and influence factors of sinusitis in nasopha- ryngeal carcinoma underwent radiation were observed, therapeutic effect of endoscopic surgery was evalua- ted. Results Twelve months after radiotherapy, the incidence of sinusitis was 82.0% , significantly higher than that before radiotherapy （47.3%）, with significant difference （P 〈 0. 05 ）. The main clinical charac- teristics was loathsome stuff, hyposmia, stuffy nose, headache, cough, sneeze, facial pain etc. Single fac- tor analysis showed that sinusitis after radiotherapy was related with tumor staging, nasal invasion, age, pathological type. Multi-factor Logistic analysis showed that tumor staging, nasal invasion were independent factors affecting sinusitis after radiotherapy. 76 sinusitis cases of nasopharyngeal carcinoma after radiothera- py underwent nasal endoscopic surgery, 41 were cured （ 53.9% ） , 26 （ 34. 2% ） showed improved, 9 （ 11.8% ） were invalid. Total effective rate was 88. 2%. Conclusions The incidence of sinusitis in naso- pharyngeal carcinoma after radiotherapy is higher, mainly related to such factors as the tumor staging, nasal invasion. Flushing of nasopharynx can effectively reduce the occurrence of radioactive sinusitis. Clinical curative effect of nasal endoscopic surgery for sinusitis in nasopharyngeal carcinoma after radiotherapy is effective. It is worth clinical promotion.