保守与鼻内镜下治疗鼻咽癌放疗后鼻窦炎的疗效比较

The efficacy comparison between conservative and endoscopic treatment for nasosinusitis after radiotherapy in nasopharyngeal carcinoma

目的探讨保守治疗与不同时机进行的鼻内镜治疗对鼻咽癌放疗后鼻窦炎的疗效差异及影响因素。方法回顾性分析96例鼻咽癌放疗后鼻窦炎的病历随访资料,按治疗方式分为保守治疗组（26例）、早期鼻内镜手术组（28例）和保守治疗无效后转鼻内镜治疗组（42例）,比较各组疗效及CT评分,Logistic回归分析疗效影响因素。结果保守治疗组总有效率65.38%、早期手术组89.29%、转手术组85.72%,三组比较差异有统计学意义（χ^2=10.15,P=0.04）;治疗后,三组患者的CT评分均较治疗前降低（P〈0.05）,早期手术组和转手术组的CT评分显著低于保守治疗组（F=10.86,P〈0.01）,其中早期手术组也显著低于转手术组（t=5.04,P〈0.01）;放疗疗效进展是影响放射性鼻窦炎疗效的保护因素（P=0.03,OR=0.64,95%CI：0.14～3.80）。结论鼻内镜下治疗鼻咽癌放疗后鼻窦炎疗效较好,且早期治疗效果更佳,其手术疗效受到放疗效果的影响。

Objective To compare the efficacy and affecting factors between conservative and endoscopic treatment fornasosinusitis after radiotherapy in nasopharyngeal carcinoma. Methods Retrospective analysis of 96 cases with nasosinusitisafter radiotherapy,then patients by the treatment were divided into conservative treatment group（CG,N=26）,early endoscopicsurgery group（ESG,N=28）,and endoscopic treatment after failure of conservative treatment group（AEG,N=42）,to comparewith the efficacy and CT scores,and the Logistic regression was used to analyze the affecting factors of the efficacy. Results The total efficiency in CG,ESG and AEG were 65.38%,89.29%,and 85.72%,respectively,and the differences were significant（χ^2=10.15,P=0.04）. After the treatment,the CT scores in CG,ESG and AEG were significantly decreased（P〈0.05）,while CTscores in ESG and AEG were significantly lower than CG（F=10.86,P〈0.01）,and ESG was significantly lower than AEG（t=5.04,P〈0.01）; Advances after radiotherapy was a protective factor affecting the efficacy of nasosinusitis（P=0.03,OR=0.64,95% CI：0.14～3.80）. Conclusion Endoscopy was efficacy for nasosinusitis after radiotherapy,and early treatment have abetter efficacy,which is affected by outcomes of radiotherapy.