颌下腺移位对防治头颈鳞癌放疗后口干燥症的作用

Submandibular salivary gland transfer for preventing radiation-induced xerostomia in patients with head and neck squamous cell carcinoma

目的评价颌下腺移位对防治头颈鳞癌放疗后口干燥症的临床疗效。方法 41例头颈鳞癌患者随机分为对照组20例和观察组21例,对照组仅行放射治疗,观察组放疗前先行单纯颌下腺移位术或肿瘤根治+颌下腺移位术,放疗时颏下区设置挡块。放疗前及放疗后6个月行^(99m)Tc核素扫描,了解患者颌下腺功能;放疗后3、6个月行口干程度问卷调查,观察口干燥症发生情况,并进行2组间比较。结果放疗前2组患者颌下腺功能均正常;放疗后6个月,观察组颌下腺摄取、分泌功能基本正常率(71.4%、66.7%)高于对照组(25.0%、20.0%)(P<0.01);放疗后3、6个月,观察组中、重度口干燥症发生率(33.3%、23.8%)均低于对照组(90.0%、80.0%)(P<0.01)。结论颌下腺移位对防治头颈鳞癌放疗后口干燥症疗效确切,可有效改善患者生存质量。

Objective To explore the effect of submandibular salivary gland transfer on preventing of radiation-induced xerostomia in patients with head and neck squamous cell carcinoma （HNSCC）. Methods Forty-one patients with HNSCC were divided into observation group （n= 21） and control group （n= 20）. Both two control group received only radiotherapy. Observation group received radical resection of tumor and/or submandibular salivary gland transfer before radiation radiotherapy and the submandibular area was shielded during radiation. The submandibular gland function and salivary fluid were detected by 99mTc scintigraphy before and 6 months before radiotherapy. All patients filled in the questionnaire of xerostomia 3 and 6 months after radiation and the results were compared between two groups. Results The suhmandibular gland function was normal before radiation. The basic normal trapping and excretion functions restoring rates of submandibular glands in observation group （71.4%, 66.7%） were significantly higher than those in control group （25.0%, 20.0%） 6 months after radiation （P〈0.01）. The incidences of moderate and severe xerostomia were significantly lower in observation group （33.3 %, 23.8%） than those in control group （90.0%, 80.0%） 3 and 6 months after radiation （P〈0.01）. Conclusion The submandibular salivary gland transfer is effective for preventing radiation-induced xerostomia in patients with HNSCC, and it can improve the life quality of the patients.