CAJ | 학술논문

目的探讨鼻咽癌放射治疗后鼻咽坏死的临床特点、诊断、治疗、预后及相关因素.方法对60例诊断明确的鼻咽癌放疗后发生鼻咽坏死患者进行回顾性分析,男50例,女10例,年龄30 ～ 70岁,中位年龄51.5岁.所有患者均行纤维鼻咽镜下鼻咽坏死清创术,感染者配合全身或局部抗感染治疗.Kruskal-Wallis H检验分析鼻咽坏死发生距末次放射治疗结束的时间(放疗-坏死间隔时间)及治疗后疗效的相关因素；Cox比例风险回归模型评价预后风险因素.结果放疗-坏死间隔时间为1 ～ 156个月,中位时间5个月；一程放疗组及多程(≥2)放疗组的放疗-坏死间隔中位时间分别为7.0和4.5个月,差异有统计学意义(X2=5.527,P=0.031)；T2组和≥T3组的中位放疗-坏死间隔时间分别为7.5和5.0个月,差异有统计学意义(x2=4.330,P=0.037).鼻咽伴有感染者41例(68.3％),感染和未感染患者疗效差异有统计学意义(X2=14.775,P＜0.001).经纤维鼻咽镜下鼻咽清创术及全身或局部抗感染治疗后,全组患者症状均有不同程度缓解.随访2 ～ 46个月,中位数12.5个月,7例死于鼻咽大出血,15例死于肿瘤或系统衰竭,5例失访,其他均存活.Cox回归分析显示颈内动脉受侵显露是影响患者预后的独立危险因素(P＜0.05).结论纤维鼻咽镜下鼻咽坏死清创术为一种有效的治疗手段,感染对鼻咽坏死的发生及疗效均有影响；放疗剂量、疗程及肿瘤分期是放疗后鼻咽坏死形成的重要因素,鼻咽坏死灶累及颈内动脉是影响预后的独立危险因素,鼻咽大出血及衰竭为主要死因.
목적 탐토비인암방사치료후비인배사적림상특점、진단、치료、예후급상관인소.방법 대60례진단명학적비인암방료후발생비인배사환자진행회고성분석,남50례,녀10례,년령30 ～ 70세,중위년령51.5세.소유환자균행섬유비인경하비인배사청창술,감염자배합전신혹국부항감염치료.Kruskal-Wallis H검험분석비인배사발생거말차방사치료결속적시간(방료-배사간격시간)급치료후료효적상관인소；Cox비례풍험회귀모형평개예후풍험인소.결과 방료-배사간격시간위1 ～ 156개월,중위시간5개월；일정방료조급다정(≥2)방료조적방료-배사간격중위시간분별위7.0화4.5개월,차이유통계학의의(X2=5.527,P=0.031)；T2조화≥T3조적중위방료-배사간격시간분별위7.5화5.0개월,차이유통계학의의(x2=4.330,P=0.037).비인반유감염자41례(68.3％),감염화미감염환자료효차이유통계학의의(X2=14.775,P＜0.001).경섬유비인경하비인청창술급전신혹국부항감염치료후,전조환자증상균유불동정도완해.수방2 ～ 46개월,중위수12.5개월,7례사우비인대출혈,15례사우종류혹계통쇠갈,5례실방,기타균존활.Cox회귀분석현시경내동맥수침현로시영향환자예후적독립위험인소(P＜0.05).결론 섬유비인경하비인배사청창술위일충유효적치료수단,감염대비인배사적발생급료효균유영향；방료제량、료정급종류분기시방료후비인배사형성적중요인소,비인배사조루급경내동맥시영향예후적독립위험인소,비인대출혈급쇠갈위주요사인.
Objective To study the clinical characteristics,diagnosis,treatment and prognostic factors of patients with postradiation nasopharyngeal necrosis(PRNN) in nasopharyngeal carcinoma(NPC).Methods Sixty patients with PRNN were studied retrospectively,50 males and 10 females,age ranging from 30-70 years of (median 51.5 years). All patients were treated with endoscopic debridement and systemic or local anti-inflammatory treatment. Kruskal-Wallis H test was used to assess the interval time between irradiation completion and necrosis onset and related factors of treatment outcome.Multivariate Cox proportional hazards regression survival analysis was performed to analyze risk factors.Results The latent period between the last irradiation and the onset of the symptom ranged from 1 to 156 months,with a median of 5 months.The median interval time was 7.0 months in 1 course group and 4.5 months in ≥ 2 courses group ( x2 =5.527,P =0.031 ),and 7.5 months in T2 group and 5.0 months in ≥T3 group ( X2 =4.330,P =O.037 ),respectively.Forty-one patients of them had nasopharyngeal infection,and the difference in curative effect between infection group and non-infection group was sigmficantly(x 2 =14.775,P ＜ 0.001 ).Symptoms were alleviated in all patients after endoscopic debridement and systemic or local anti-inflammatory treatment.Follow-up for all patients ranged from 2 to 46 months (median 12.5 months).Seven patients with internal carotid artery exposure died of sudden nasopharyngeal massive bleeding and fifteen patients died of tumor or systemic exhaustion; five cases were lost,and the rest were all in survival. Inter carotid artery erosion was an independent prognostic risk factor according to multivariate Cox proportional hazards regression survival analysis ( P ＜ 0.05 ). Conclusions Endoscopic debridement is effective in treating irradiation-related nasopharyngeal necrosis. The occurrence of nasopharyngeal necrosis is related to infection,irradiation dose and course,and T stage.Internal carotid artery erosion is a severe situation and also an independent prognostic factor for the patients.The most common causes of death were nasopharyngeal bleeding and systemic exhaustion.