腮腺保留式调强放疗对唾液组成、流量及口干的影响

Effect of parotid sparing intensity modulated radiation therapy on salivary composition, flow and dry mouth prevention

目的:探讨头颈部鳞状细胞癌患者经腮腺保留式调强放疗后唾液组成、流量及口干的变化。方法:收集2016年5月—2018年11月庆阳市人民医院进行放疗的头颈部鳞癌患者101例,按照治疗方法分为调强放疗组(54例)与常规放疗组(47例),比较2组患者临床病理特征参数,治疗前、后腮腺摄取指数,治疗后唾液成分、口干、口咽反应症状与分度。采用SPSS 20.0软件包对数据进行统计学分析。结果:2组患者肿瘤部位、TNM临床分期与分化程度无显著差异(P>0.05);治疗后调强放疗组患者唾液中总蛋白,分泌型IgA,钙、磷浓度显著大于常规放疗组(P<0.05);治疗后2组患者腮腺摄取指数、分泌指数与唾液流速较治疗前显著下降(P<0.05);且调强放疗组患者腮腺摄取指数、分泌指数与唾液流速显著大于常规放疗组(P<0.05);调强放疗组治疗后口干情况显著优于常规放疗组(P<0.05);治疗后调强放射组出现咽痛与咽下困难患者比例显著低于常规放疗组(P<0.05);调强放疗组患者治疗后口咽分度情况显著优于常规放疗组(P<0.05)。结论:腮腺保留式调强放疗对唾液组成、流量及口干情况影响较小,对腮腺分泌功能有显著保护作用。

PURPOSE:To investigate the changes of salivary composition,flow and dry mouth in patients with head and neck squamous cell carcinoma after parotid sparing modulated radiation therapy.METHODS:One hundred and one patients with head and neck squamous cell carcinoma who received radiotherapy in Qingyang People’s Hospital from May2016 to November 2018 were selected and divided into intensity modulated radiation group(n=54)and conventional radiation group(n=47)according to different treatment methods.The clinicopathological parameters,parotid uptake index,salivary composition,dry mouth,oropharyngeal symptoms and grading were compared between the two groups.The data were analyzed with SPSS 20.0 software package.RESULTS:The tumor site,TNM stage and differentiation had no significant difference between the two groups(P>0.05).The concentration of total protein,secretory IgA,calcium and phosphorus in saliva of patients in intensity modulated radiation therapy group were significantly higher than those in conventional radiation group(P<0.05).The parotid uptake index,secretion index and salivary flow velocity were significantly decreased in both groups(P<0.05),and were significantly lower in the conventional radiation group than in the intensity modulated radiation group(P<0.05).Dry mouth condition in intensity modulated radiation group was significantly better than that in conventional radiation group(P<0.05).After treatment,the ratio of pharyngalgia and dysphagia patients in the intensity modulated radiation group was significantly lower than that in the conventional radiation group(P<0.05).The degree of oropharyngeal grading in the intensity modulated radiation therapy group was significantly better than that in the conventional radiation group(P<0.05).CONCLUSIONS:The application of parotid sparing retention modulated radiation therapy has little effect on salivary composition,flow rate and dry mouth,and has obvious protective effect on parotid secretion.