鼻咽癌放疗后颅底骨感染坏死的治疗体会

The treatment experience on osteoradionecrosis of skull base with nasopharyngeal carcinoma after radiotherapy

目的探讨鼻咽癌放疗后颅底放射性骨坏死(ORN)的临床处理策略。方法收集11例确诊为鼻咽癌ORN的病历资料,分析其临床表现、诊断、治疗及预后特点。结果 7例鼻咽部放射性骨坏死(NORN)患者中(其中3例合并上颌骨坏死),2例于术后1年分别因颅内感染、肺部感染死亡,其余5例生存患者中,3例感染控制,骨质坏死未见扩大(1例随访5年,1例随访3年,1例随访1年),2例骨坏死范围均有不同程度扩大(1例随访1年,1例随访8个月)。4例颞骨放射性骨坏死(TORN),其中3例为局限性,1例术腔完全上皮化(随访3年),2例术腔间断性渗出(分别随访1年、2年),上述3例均未发现有明显的骨质坏死扩大现象。另1例为广泛性坏死,最终死于颈内动脉破裂大出血。11例中有3例行责任血管栓塞治疗。结论鼻咽癌放射治疗后引起的颅底骨感染坏死病情复杂,早期积极采用内镜下彻底清除坏死骨质是治疗该病的有效途径。责任血管栓塞既可避免突发大出血,降低死亡率,又能降低手术风险,彻底清理坏死灶。

Objective To investigate the clinical treatment strategies of osteoradionecrosis of skull base （ORN） in the patients with nasopharyngeal carcinoma（NPC） after radiotherapy. Methods All patients （ n = 11 ） diagnosed as NPC and osteoradionecrosis of the skull base were studied retrospectively with their clinical manifestations, diagnoses, therapies and prognoses. Results In the NORN group, 2 cases died of intracranial and lung infections respectivelylyear after the treatment. Out of the 5 survivors, 3 was in the stationary state （one was followed up five years, 1 three years and 1 one year）and the other 2 were presented with repeated infection and expansion of the osteoradionecrosis lesion （one was followed up one year, one eight months）. In the TORN group, 3 patients had localized necrosis, of which one had complete epithelialization （followed up 3 years） and two had continuous seepage （ followed up 1 and 3 years separately）, and they were not presented with expansion of the osteoradionecrosis lesion. The last patient died of massive expistaxis due to internal carotid blowout. Three patients of the group executed responsibility vascular embolization. Conclusion For ORN, early and complete clean up of the necrotic tissue by endoscopy is an effective method. Responsibility vascular embolozation can not only avoid excessive bleeding and reduce mortality, but also reduce the operation risk and thoroughly clean the necrosis.