鼻咽癌放射治疗后颅底骨坏死的诊断和治疗

目的 探讨鼻咽癌放射治疗(简称放疗)后颅底放射性骨坏死的诊断和治疗，提高本病的诊治水平。方法 对15例确诊的鼻咽癌颅底骨坏死患者的资料、临床症状及体征、治疗方式等特点进行分析与总结。结果 颅底放射性骨坏死的常见症状为恶臭、头痛和鼻衄；内镜表现为鼻咽坏死，可见骨质裸露或死骨形成。CT特征性表现：骨破坏广泛而对称或局限；骨体的表面裸露在气腔中；有死骨形成；软组织内见小气泡。9例局限性颅底骨坏死手术治疗，2例死于放射性颞叶坏死，生存7例，生存时间2～7年。5例广泛颅底骨坏死和1例局限性颅底骨坏死保守治疗，3例死于鼻咽大出血，1例死于呼吸循环衰竭，生存2例，生存时间3～5年。结论 颅底骨坏死根据症状结合CT或磁共振成像(magneticresonance imaging，MRI)及内镜特征可作出临床诊断，确诊须病理证实；手术治疗效果最佳。广泛颅底骨坏死伴放射性脑损伤或颅神经损伤者预后较差，鼻咽大出血及衰竭为主要死因。

Diagnosis and treatment on osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma]

OBJECTIVE: To investigate the diagnosis and management on osteoradionecrosis (ORN) of skull base in the patients with nasopharyngeal carcinoma (NPC) after radiotherapy. METHODS: All patients (n = 15) diagnosed as NPC and ORN of skull base were studied on the clinical data, diagnosis and therapy. RESULTS: All the patients were found with foul odor, headache, bleeding and exposed necrotic bone. 9 patients were treated by surgery, among them 2 patients died of temporal lobe radionecrosis, and the survival time of remaining 7 patients was 2 to 7 years. 5 patients with extensive ORN and 1 patient with local ORN were treated by conservative methods, among them 3 died of nasopharyngeal bleeding and 1 died of respiratory and heart failure, survival time of the remaining 2 patients was 3 to 5 years. CONCLUSIONS: ORN can be diagnosed by clinical characteristics, CT or MR, and endoscopic findings. Surgery is the best choice for ORN. The patients with extensive ORN or radiation-induced cranial neuropathy had poor prognosis. The most common causes of death were nasopharyngeal bleeding and exhaustion.