不同鼻腔冲洗方式对鼻咽癌的远期生存、鼻窦炎及生存质量影响

目的 探讨不同鼻腔冲洗方式对鼻咽癌的远期生存、鼻窦炎发生率及生存质量影响，为鼻咽癌最佳鼻腔冲洗方式提供临床依据。方法 依据随机数字表将本院2003年8月至2010年12月的1134例鼻咽癌患者随机分为3组（n=378）：A组采用一次性鼻腔冲洗机；B组采用自制鼻腔冲洗接头联合灌肠器；C组采用鼻腔喷雾器。分析3组的放疗急性不良反应并随访远期生存情况，分别于治疗前（T0）、治疗6个月（T1）、治疗1年（T2）、治疗2年（T3）和治疗3年（T4）采用中文版鼻腔鼻窦结局测量20条（SNOT-20）调查各组的生存质量并记录各组鼻咽炎发生率。结果 全组共随访3～92个月，5年总生存率和无进展生存率分别为80.5％和73.2％。3组中位总生存期和无进展生存期的差异无统计学意义（P＞0.05）；3组唾液腺损伤和颈部皮肤损伤发生率的差异无统计学意义（P＞0.05）；C组3～4级口咽黏膜损伤的发生率高于其余两组（P＜0.05），且A、B两组发生率的差异无统计学意义（P＞0.05）；全组T0、T1、T2、T3、T4的鼻窦炎发生率分别为41.7％、56.3％、74.0％、54.1％和69.6％，A组T2、T3、T4的鼻窦炎发生率均低于其余两组，B组T2的发生率低于C组，但T4高于C组，以上差异均有统计学意义（P＜0.05）；3组T1、T2的鼻窦炎症状积分均低于T0（P＜0.05），仅C组T3、T4的积分低于T0（P＜0.05），其余均与T0的差异无统计学意义（P＞0.05），且C组T2、T4的积分均低于其余两组（P＜0.05）。结论 不同鼻腔冲洗方法对鼻咽癌患者的远期生存无明显影响，但鼻腔喷雾器可增加口咽黏膜损伤的风险，且采取该方法在随访期间内患者的生存质量最差。

Influences of different methods of nasal irrigation on long-term survival,incidence of sinusitis and quality of survival of patients with nasopharyngeal carcinoma

Objective To explore the influences of different methods of nasal irrigation on long-term survival, incidence of si-nusitis and quality of survival of patients with nasopharyngeal carcinoma （ NPC） . Methods According to the random number table, 1134 patients with NPC from July 2008 to December 2012 of our hospital were randomly assigned to receive nasal irrigation by nasal wash machine （ group A） , homemade nasal irrigation fittings combined with enemator （ group B） or nasal spray （ group C） with 378 for each. All patients were followed up for long-term survival and the acute adverse reactions were recorded. The Sino-Nasal Outcome Test 20 was employed to investigate the quality of survival before treatment （ T0 ） and at 6th month （ T1 ） , 1st year （ T2 ） , 2nd year （ T3 ） and 3rd year （ T4 ） after treatment, respectively. Meanwhile, the incidence of sinusitis was recorded. Results All patients were fol-lowed up for 3 to 92 months with 5-year overall survival rate and progression-free survival rate of 80.5% and 73.2%. No significant differences were observed among three groups on overall survival, progression-free survival and incidences of salivary gland and neck skin damage. The incidence of grade 3/4 oropharyngeal mucosa damage of group C was higher than those of other two groups with sig-nificant difference （P＆lt;0.05）. The incidences of sinusitis at T0, T1, T2, T3 and T4 were 41.7%, 56.3%, 74.0%, 54.1% and 69.6%. The incidences of sinusitis at T2 , T3 and T4 of Group A were lower than other two groups （ P＆lt;0.05） . There were a lower inci-dence at T2 and a higher incidence at T4 in Group B versus Group C （ P＆lt;0.05） . The sinusitis symptom scores at T1 and T2 were lower＆amp;nbsp;than those at T0 in all three groups （ P＆lt;0.05） , while only the Group C’ s sinusitis symptom scores were lower at T3 and T4 than T0（ P＆lt;0.05）. The Group C’s sinusitis symptom scores were lower than other two groups at T2 and T4（P＆lt;0.05）. Conclusion Different methods of nasal irrigation had no influence on the long-term survival of patients with NPC. Nasal spray can increase the risk of oropha-ryngeal mucosa damage with a worst quality of survival during the follow-up.