鼻咽癌放疗后并发分泌性中耳炎的特征及相关因素分析

Analysis of characteristics and related factors of secretory otitis media after radiotherapy for nasopharyngeal carcinoma

目的观察鼻咽癌放疗后并发分泌性中耳炎的特征,分析其相关因素。方法选择大同市第五人民医院2015年1月至2017年1月诊治的鼻咽癌放疗后并发分泌性中耳炎患者184例为观察组,另选择同时段未合并分泌性中耳炎的鼻咽癌放疗患者56例为对照组观察和记录鼻咽癌患者放疗后发生分泌性中耳炎的时间和部位,比较两组患者临床资料,分析其相关因素结果184例患者中,单侧占67.4%,双耳占32.6%。放疗12个月发病比例最高,为44. 6%(82/184) 。与对照组比较,观察组放疗时间[(13.6 ±4.8)个月]更长,接受放射剂量[(72.7 ±26. 8) Gy]更大,咽鼓管受累比例(65.2%).肿瘤分期T3?T4期比例(55.4%)及腭帆张肌萎缩M30%比例(63.0%)更高,差异均有统计学意义(t = 6. 231.5. 683, χ^2 = 8,944.5.527 、7.198,均P<O.05)。logistic多因素分析显示,放疗剂量M70 Gy、腭帆张肌萎缩工30%、肿瘤T3 ~T4分期、咽鼓管受累及放疗时间为鼻咽癌患者放疗后发生分泌性中耳炎危险因素(结论鼻咽癌放疗后并发分泌性中耳炎单侧多见,放疗时间、放疗剂量、肿瘤分期、咽鼓管受累及腭帆张肌萎缩均是其危险因素。

Objective To observe the characteristics of secretory otitis media after radiotherapy for nasopharyngeal carcinoma( NPC) and analyze its related factors. Methods From January 2015 to January 2017 ,one hundred and eighty - four NPC patients with secretory otitis media after radiotherapy in the Fifth Peoples Hospital of Datong were selected as observation group, and 56 NPC patients without secretory otitis media were selected as control group. The time and location of secretory otitis media after radiotherapy for NPC patients were observed and recortled. The clinical data of the two groups were compared,and the related factors were analyzed. Results Of the 184 patients,67. 4% patients were unilateral and 32. 6% patients were double ears. Twelve months after radiotherapy, the highest incidence rate was 44. 6%( 82/184). Compared with the control group, the radiotherapy time of the observation group[( 13. 6 ± 4. 8 ) months] was longer, the radiation dose[( 72. 7 ± 26. 8 ) Gy ] was greater, the proportion of the eustachian tube involvement(65. 2%), the T3 - T4 phase of the tumor stage(55. 4%) and the atrophy of the palatine tensor muscle of the palatine velum more than or equal to 30%(63. 0%) were higher,and the differences were statistically significant (Z = 6. 231 ,5. 683 ,χ^2 =8.944,5.527,7. 198,all P < 0. 05 ). Logistic multivariate analysis showed that the radiation dose of more than 70Gy, palatine tensor muscle atrophy more than 30%, tumor T3 - T4 staging, eustachian tube involvement and radiotherapy time were the risk factors of secretory otitis media in NPC patients after radiotherapy. Conclusion The postoperative radiotherapy of NPC with secretory otitis media is often in one side. The risk factors are the time of radiotherapy, the dose of radiotherapy, the tumor stage, the involvement of the eustachian tube and the atrophy of the palatine tensor muscle.