三维放射治疗鼻咽癌并发分泌性中耳炎的临床研究

Three-dimensional radiotherapy for nasopharyngeal carcinoma complicated with secretory otitis media

目的探讨鼻咽癌患者三维放射治疗后并发分泌性中耳炎的影响因素。方法选取2015年1月至2017年1月间于汉中市中心医院接受三维放射治疗的74例鼻咽癌患者为研究对象,根据放疗后是否并发分泌性中耳炎(SOM)分为观察组(并发SOM)与对照组(未并发SOM),每组37例。分析观察组患者的临床特点,并用Logistic回归分析鼻咽癌放疗后并发SOM的影响因素。结果观察组患者放疗后12个月的发病率最高,与其他时点比较,差异均有统计学意义(均P <0. 05)。单因素分析结果表明,与鼻咽癌放疗后并发SOM有关的因素为腭帆张肌萎缩≥30%、咽鼓管受累、放疗剂量≥70Gy和放疗时间,差异均有统计学意义(均P <0. 05),而患者性别、年龄、肿瘤病理分期(T1~T4期)、放疗剂量等因素与鼻咽癌放疗后并发SOM无关,差异无统计学意义(P> 0. 05)。多因素Logistic回归分析结果显示,放疗剂量≥70Gy和放疗时间是鼻咽癌放疗后并发SOM的独立危险因素,腭帆张肌萎缩≥30%、咽鼓管受累是鼻咽癌放疗后并发SOM的危险因素,差异均有统计学意义(均P <0. 05)。结论鼻咽癌患者三维放射治疗后并发SOM的概率较高,可能与放疗损伤咽鼓管功能有关,且放疗剂量越大、时间越长,咽鼓管损伤程度越严重,并发SOM的风险越高,故临床治疗鼻咽癌时应合理选择放疗方案,避免大剂量长时间放疗,从而降低并发SOM的风险。

Objective To explore the factors influencing secretory otitis media after three-dimensional radiotherapy for nasopharyngeal carcinoma.Methods Seventy-four patients with nasopharyngeal carcinoma who received three-dimensional radiotherapy at Hanzhong Central Hospital from January 2015 to January 2017 were selected as the study subjects.According to whether they had secretory otitis media(SOM)after radiotherapy or not,they were divided into an observation group(complicated with SOM)and a control group(without SOM)with 37 patients in each group.The clinical characteristics in observation group were analyzed.Logistic regression was used to analyze factors influencing SOM after radiotherapy for nasopharyngeal carcinoma..Results For the observation group,the incidence of SOM reached the highest at 12 months compared with other time points(P<0.05).Univariate analysis showed that palatosalpingeus atrophy≥30%,eustachian tube involvement,radiotherapy dose≥70 Gy and radiotherapy time were factors influencing SOM after radiotherapy for nasopharyngeal cancer(all P<0.05).However,patient’s gender,age,tumor pathology,tumor staging(T1~T4 phase),and radiotherapy dose were not associated with SOM after radiotherapy for nasopharyngeal carcinoma(all P>0.05).The multivariate logistic regression analysis showed that the radiotherapy dose≥70 Gy and the radiotherapy time were independent risk factors for SOM after radiotherapy for pharyngeal carcinoma,and sputum atrophy≥30%and eustachian tube involvement were risk factors for SOM after radiotherapy for nasopharyngeal carcinoma(all P<0.05).Conclusion The probability of SOM is high after three-dimensional radiotherapy for nasopharyngeal carcinoma,which may be related to the eustachian tube function.The greater the dose of radiotherapy,the longer the time,the more serious the damage of eustachian tube,the higher risk of SOM is.Therefore,in the clinical treatment of nasopharyngeal carcinoma,radiotherapy should be rationally selected to avoid high-dose,long-term radiotherapy,thereby reducing the risk of SOM.