鼻咽癌放疗后继发慢性鼻窦炎的临床特征

doi:10.6040/j.issn.1673-3770.0.2014.115

摘要/Abstract

摘要： 目的分析鼻咽癌放疗后继发慢性鼻窦炎的临床特征。方法对2011年1月至2013年5月来我科门诊及住院治疗的放疗致慢性鼻窦炎患者(放疗组)及单纯慢性鼻窦炎患者(对照组)各40例行视觉模拟评分法(VAS)评价鼻部主观症状、鼻内镜检查、鼻窦CT检查, 并给予相应评分。放疗组中15例及对照组中36例接受鼻内镜鼻窦手术, 术中行上颌窦穿刺, 抽取脓性分泌物行细菌培养。结果 VAS评分:放疗组为鼻塞4.0±0.8, 流脓涕6.5±1.2, 头痛4.3±0.6, 嗅觉减退5.1±1.4, 咳嗽2.7±1.2, 打喷嚏3.7±0.8, 面部疼痛和压迫感4.3±1.2, 耳痛5.3±1.1;对照组为鼻塞4.3±0.7, 流脓涕5.3±1.0, 头痛3.3±0.8, 嗅觉减退4.0±0.9, 咳嗽3.3±1.0, 打喷嚏3.7±0.9, 面部疼痛和压迫感2.2±0.5;其中流脓涕、耳痛症状放疗组较对照组明显;鼻窦CT Lund-Mackay评分: 放疗组为8.2±1.1, 对照组为 6.5±1.3;鼻内镜Lund-Kenndy评分:放疗组为6.2±1.1, 对照组为4.7±0.7;上颌窦分泌物细菌培养结果:放疗组以金黄色葡萄球菌(6/15)、流感嗜血杆菌(3/15)为主, 还有部分未查到细菌生长(4/15);对照组以金黄色葡萄球菌(24/36)、流感嗜血杆菌(6/36)、草绿色链球菌(5/36)为主。结论放疗致鼻窦炎较单纯慢性鼻窦炎有其自身特点, 其发生机制可能与放射损伤鼻窦纤毛功能, 窦口肿胀、阻塞, 继发细菌感染有关。

关键词: 鼻咽肿瘤, 并发症, 慢性鼻窦炎, 放射治疗

Abstract: Objective To investigate the characters of chronic sinusitis induced by radiotherapy for nasopharyngeal carcinoma. Methods The clinical data of 40 chronic sinusitis patients induced by radiotherapy for nasopharyngeal carcinoma (the radiotherapy group) and 40 common chronic sinusitis patients (the control group) enrolled in our department from January 2011 to May 2013 were retrospectively analyzed. All patients were measured the symptom visual analysis scale (VAS) and took endoscopic examination and sinus CT scanning. A total of 18 patients of the radiotherapy group and 36 patients of the control group accepted endoscopic surgery, during the operation, purulent secretion in the maxillary was exacted and bacterial culture was done. Results As to the VAS, nasal secretion was significantly more severe in the experimental group (6.5±1.2) in comparison with the control group (5.3±1.0, P<0.05). As to the endoscopic finding, more dry and more curst in the postior nasal cavity and nasopharynx, the Lund-Kenndy score was 6.2±1.1 in the experimental group vs 4.7±0.7 in the control group. The main reasons laid in high CT scores and high involved rates of ostiomeatal complex, frontal sinus, maxillary sinus and anterior ethmoid sinus. Conclusion The characters of chronic rhinosinusitis caused by radiotherapy are quite different from those of the common chronic sinusitis. The mechanism of chronic sinusitis induced by radiotherapy prefers to obstruction of the ostium or dysfunction of the cilia continued with bacterial infection.

Key words: Complications, Chronic sinusitis, Nasophrangeal carcinoma, Radiotherapy

中图分类号:

R739.2

唐隽, 施思斯, 于青青, 萧建新, 张超. 鼻咽癌放疗后继发慢性鼻窦炎的临床特征[J]. 山东大学耳鼻喉眼学报, 2015, 29(2): 52-54.

TANG Jun, SHI Si-si, YU Qing-qing, XIAO Jian-xin, ZHANG Chao. Clinical characters of chronic sinusitis induced by radiotherapy for nasopharygeal carcinoma[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2015, 29(2): 52-54.

参考文献

[1] 陈伊宁,黄光武,温文胜, 等.113例鼻咽癌放疗患者放疗前后鼻疾病分析[J].耳鼻咽喉-头颈外科,2003,10(1):32-35. CHEN Yining, HUANG Guangwu, WEN Wensheng, et al. Analysis of nasal diseases before and after radiotherapy of 113 cases of nasopharyngeal carcinoma [J]. Otorhinolaryngol, 2003,10(1):32-35.
[2] 张学辉,黄健男, 彭树文, 等. 放射性鼻窦炎337例临床分析[J].中华实用医学, 2003,5(6):33-34. ZHANG Xuehui, HUANG Jiannan, PENG Shuwen, et al. Clinical analysis of 337 cases of radioactive sinusitis[J]. Chin Prac Med, 2003, 5(6):33-34.
[3] 陈怀宏,吴德华,梁勇, 等. 鼻咽癌放射治疗后继发慢性鼻-鼻窦炎的临床特征分析[J].中华耳鼻咽喉头颈外科杂志,2009,44(4):307-310. CHEN Huaihong, WU Dehua, LIANG Yong, et al. Analysis of clinical characters of chronic rhinosinusitis in patients with postirradiated nasopharyngeal carcinoma[J]. Chin J Otorhinolaryngol Head Neck Surg, 2009, 44(4):307-310.
[4] 刘阳云,陈志喜,江文,等.不同的评估指标在鼻咽癌放疗后慢性鼻-鼻窦炎治疗方案选择和疗效评估中的价值[J]. 山东大学耳鼻喉眼学报, 2014, 28(1):22-26. LIU Yangyun, CHEN Zhixi, JIANG Wen, et al. Evaluation indexes for treatment plan and curative effect evaluation in nasopharyngeal carcinoma patients with postradiotherapy chronic rhinosinusitis[J]. J Otolaryngol Ophthalmol Shandong Univ, 2014, 28(1):22-26.
[5] Deng Z Y, Tang A Z. Bacteriology of postradiotherapy chronic rhinosinusitis in nasopharyngeal carcinoma patients and chronic rhinosinusitis[J]. Eur Arch Otorhinolaryngol, 2009, 266(9):1403-1407.

相关文章 15

[1]	翟雪纯,边欣,陈敬彩,邓家钰,叶子,杨萍丽. 慢性额窦炎患者焦虑抑郁特点及横断面研究[J]. 山东大学耳鼻喉眼学报, 2026, 40(2): 35-43.
[2]	卢朝阳, 翟兆雪, 王慧康, 邵丽婷, 张宇. 新冠肺炎治疗引发糖尿病酮症酸中毒合并鼻眶脑型毛霉菌病1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 90-94.
[3]	李阳松,袁发洋,杨艳,张田,喻国冻. 基于Web of Science进行生物制剂治疗慢性鼻窦炎文献计量学分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 54-64.
[4]	杜康丽,郑振宇,徐战将,张宇,陈露,卢梦垚. 鼻中隔偏曲并发慢性鼻窦炎风险预测模型的构建与验证[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 78-86.
[5]	熊琴, 张砚, 乌日娜, 李锋, 唐力行. 鼻用糖皮质激素在儿童中的应用[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 160-167.
[6]	刘玉柱,苑铁君,李波. 会厌原发神经内分泌癌1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 97-100.
[7]	邱前辉,肖旭平,杨钦泰,叶菁,邓泽义,王德生,谭国林,蒋卫红,卢永田,唐隽,石照辉,邓晓聪,刘遗斌,王跃武,段传志,杜德坤,白小欣,陈文伙,莫立根,蔡楚伟,曾鹏,何旭英,杨一梅,赵洲洋,陈健龙,赵充,林志雄,李先明,李曙平,陈冬平,陈勇,黄莹,陈春燕,韩非,黄理金,瞿申红. 鼻咽癌治疗后并发颈动脉爆裂综合征的临床处理专家共识[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 1-18.
[8]	朱瑞楷,吴家荣,孙芳,谢楚波,邱前辉. 基于计算机断层扫描血管造影术评估鼻咽癌放疗后引起颈内动脉狭窄状况及其影响因素的研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 77-84.
[9]	马馨,董凌康,吴红敏,易红良,邹建银. 外展悬吊缝合技术在阻塞性睡眠呼吸暂停治疗中的改良及应用进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 81-88.
[10]	张广玲,陈兴雪,武天义,孙占伟,王卫卫,李世超,王广科. Tespa1在慢性鼻窦炎伴鼻息肉中的表达及作用研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 35-42.
[11]	王文晴,张丹,朱梦迪,王路阳,杨培培,孙思思,张秋敏,周慧. 慢性鼻窦炎伴鼻息肉复发手术时临床及组织病理学特征变化[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 46-53.
[12]	王奥维,时文杰. CRSwNP中医证型与TFH细胞相关因子的相关性研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 54-60.
[13]	张婕,尼玛吉宗,徐小东,周菁,刘建敏,罗依蕤,杜进涛,巴罗. 藏红花素在嗜酸性慢性鼻窦炎伴鼻息肉中调控2型炎症反应的研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 61-67.
[14]	张韵秋,任秀敏,徐鸥,董金辉,王建星. 奥马珠单抗靶向治疗慢性鼻窦炎伴鼻息肉的研究进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 136-140.
[15]	李婷,赵冲,吴献. 鼻黏膜组织中miR-34a表达与慢性鼻窦炎患者术后复发的关系[J]. 山东大学耳鼻喉眼学报, 2024, 38(5): 20-25.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed