Velopharyngeal stenosis, a late complication of radiotherapy

Choanal stenosis has recently been recognized as a late complication of radiation therapy for nasopharyngeal carcinoma. The management of velopharyngeal stenosis is challenging with high risk of restenosis. We report a case of velopharyngeal stenosis post-radiotherapy and illustrated the use of mitomycin-C to prevent restenosis. Mitomycin-C application has being shown useful adjunct to surgical technique in managing nasopharyngeal stenosis for surgeons.     

鼻咽癌放疗后后鼻孔闭锁的治疗

目的：探讨鼻内窥镜下放射性后鼻孔闭锁成形术的治疗效果。方法：回顾分析19例行鼻内窥镜下放射性后鼻孔闭锁成形术的临床资料。结果：19例手术均顺利完成,无并发症,随访2-3年,后鼻孔直径均大于1．0cm,鼻腔通气良好,无再狭窄和闭锁。结论：此法具有操作简便、术野清晰、组织损伤轻、随访方便等优点,放射性后鼻孔闭锁的临床分型对该术式的围手术期处理有指导意义。     

鼻咽癌放疗后腭咽功能障碍的诊治

目的〓〖HTK〗探讨鼻咽癌放疗后腭咽功能障碍的可能原因及诊治措施。〖HTW〗方法〓〖HTK〗对16例鼻咽癌放疗后出现腭咽功能障碍患者（14例软腭功能障碍,2例软腭功能障碍合并硬腭穿孔）的临床诊断与处理资料行回顾性分析。〖HTW〗结果〓〖HTK〗本组病例放疗量为68～75Gy,平均放疗量70Gy,疗程2个月;腭咽功能障碍均在放疗5年后出现症状,平均发病为放疗后8.3年,2例合并硬腭穿孔者的发病都在放疗10年后出现。开放性鼻音、进食经鼻反流是腭咽功能障碍的主要症状,经体位压力进食法、带腭护板及经常性的鼻腔清洗治疗,症状可得到缓解。〖HTW〗结论〓〖HTK〗鼻咽癌放疗后腭咽功能障碍的发展缓慢,在常规放疗根治量范围内,放疗量并非主要的原因,个体的差异可能更重要;硬腭穿孔是慢性缺血性骨坏死的结果。根据患者的情况采取适当的治疗措施可以缓解症状,提高生活质量。     

彩色多普勒超声评估诊断鼻咽癌放疗后颈动脉狭窄的效果及价值探讨

目的分析彩色多普勒超声(CDFI)诊断鼻咽癌(NPC)放疗后颈动脉狭窄的效果及价值。方法将2018年3月~2020年3月作为研究时间段,选取期间我院接诊的100例NPC放疗后颈动脉狭窄患者,均行CDFI检查,对诊断结果展开分析。结果(1)本组病例共检出5例完全闭塞(5.00%)、9例重度狭窄(9.00%)、31例中度狭窄(31.00%)、55例轻度狭窄(55.00%);(2)在颈动脉斑块类型方面,以硬斑块居多,共51例(51.00%);(3)颈动脉斑块主要累及颈总动脉(46.00%)。结论CDFI对于诊断NPC放疗后颈动脉狭窄有较好效果,能够明确颈动脉狭窄程度、斑块类型、斑块分布部位以及累及血管,值得推广。     

Late complications of radiotherapy for nasopharyngeal carcinoma

Objective

To evaluate and assemble late complications of radiotherapy in cases of nasopharyngeal cancer.

Methods

From October 2003 to January 2005, a prospective cohort study was done in a tertiary center, Chiang Mai University Hospital. Two hundred patients were evaluated for late complication according to the RTOG/EORTC late radiation morbidity scoring criteria.

Results

Of 200 patients, 131 were male (65.5%) and 69 female (34.5%). The mean age was 49.7 ± 13.5 years (11–78). The mean pre- and post-treatment body mass indexes (BMI) were 22.5 ± 4 (15–35.6), and 19.8 ± 3.2 (12.9–34.5; P < 0.05). Mean post-radiation period was 3.6 ± 3.4 years (0.3–18.6 years). The radiation dosage ranged from 60 to 76 Gy (mean 69 Gy). Most of the patients (92%) had undifferentiated (50.5%) and poorly differentiated (41.5%) squamous cell carcinoma. Eighty-eight percent of the patients were in Stage III and IV. Chemotherapy was given to 145 patients (72.5%). The mean post-radiation period in the added chemotherapy group was lower than the group treated with radiation alone (2.9 ± 2.7 years vs. 5.4 ± 4.4 years, P < .05). The most common complication was dryness of mouth (97.5%); followed by hearing impairment (inner ear 82.5%). Added chemotherapy increased the complication severity significantly for the skin (P < 0.05). The mean number of complications was 6.3 ± 2.2 (range from 1 to 12).

Conclusion

In this study, every patient had a more or less adverse reaction to radiation. Doctors need to be aware of these complications in order to prevent serious ones and to improve the patients’ quality of life in the long term.     

鼻咽癌放疗后鼻咽部出血原因分析及治疗对策探讨

目的探讨鼻咽癌放疗后鼻咽部出血的原因及治疗对策。方法回顾性分析2012年1月—2017年12月住院的25例鼻咽癌放疗后导致鼻咽部出血患者的临床资料,治疗方法主要包括鼻咽鼻腔填塞、鼻内镜下鼻咽痂皮及坏死肉芽清创、介入治疗、低温等离子手术止血、鼻内镜下鼻咽肿瘤切除术。结果25例患者中,由鼻咽癌复发引起鼻咽出血8例,其中3例大出血死亡;5例由假性动脉瘤引起,其中3例大出血死亡,2例经介入治疗止血;11例为鼻咽放疗后痂皮及肉芽出血,其中有7例经低温等离子手术成功止血,3例经介入后止血,1例经填塞止血;1例不明原因大出血窒息死亡。结论鼻咽癌放疗后鼻咽部出血是致死率高的并发症, 其中以鼻咽癌复发及假性动脉瘤危险性最高。积极检查明确出血原因,采取有针对性的治疗措施,能够有效降低鼻咽癌放疗后出血的死亡率。     

Incidence of long-term ipsilateral and contralateral ototoxicity following radiotherapy for nasopharyngeal carcinoma

Objective

To characterize the long-term adverse effects of radiotherapy on the ears in patients with nasopharyngeal carcinoma (NPC), we investigated ipsilateral and contralateral ototoxicities in the external, middle, and inner ear.

Methods

The records of 48 ears in 24 radiotherapy-treated NPC patients were retrospectively analyzed. Radiotherapy doses varied between 60 and 70 Gy in 2-Gy fractions at 5 fractions/week. Ototoxicities were identified by otoscope and pure-tone audiograms conducted at 2-3 month intervals for ≥12 months. The relationship between radiation dosage and sensorineural threshold deterioration was statistically compared using the Mann-Whitney U-test.

Results

Post-radiotherapy, 50% of all ears (3 of 6) that developed severe otitis externa were on the contralateral side. There was a post-radiotherapy increase in contralateral otitis media with effusion (OME) (1-7 ears), but a decrease in ipsilateral cases (16-12 ears), with 2 ears on either side subsequently developing chronic otitis media (COM). All ears that showed sensorineural hearing loss (SNHL) before radiotherapy exhibited a further threshold deterioration of more than 15 dB. No statistically significant difference (p = 0.086) in average radiation dose was seen between ears with sensorineural threshold deterioration (50.0 Gy) and those without (48.2 Gy).

Conclusion

Long-term ototoxicity following radiotherapy for NPC can occur in either the ipsilateral or contralateral ears. Pathophysiology varies between and within each side. The post-therapy increase in OME on the contralateral side was thought to be due to radiotherapy-induced Eustachian tube damage, and the sensorineural threshold deterioration in at least 4 ears was thought to be due to chronic cochlea damage secondary to COM.     

鼻咽癌放疗后并发鼻窦炎

目的 探讨鼻咽癌患者在放射治疗后鼻窦炎的发生、发展及其影响因素.方法 回顾性分析蚌埠医学院第一附属医院2000年～2005年256例鼻咽癌患者资料,通过比较放疗前、后鼻咽部CT,总结放疗前无鼻窦炎症状而放疗后发生鼻窦炎的情况.结果 放疗前鼻窦炎发生率为43.8％ (112/256),放疗前无鼻窦炎症状而放疗后出现鼻窦炎...     

鼻咽癌放射治疗后鼻窦炎相关因素分析

目的　研究鼻咽癌放射治疗后鼻窦炎的发生率、临床特点及相关因素。方法　通过观察 5 13例鼻咽癌放射治疗前后的鼻咽及鼻窦临床症状和影像学改变特点 ,分析鼻咽癌放射治疗后放射性鼻窦炎的发生率和影响因素。结果　 5 13例鼻咽癌患者中 ,放射治疗前 5 1例伴有鼻窦炎(9 9% ) ,4 6 2例无鼻窦炎表现 (90 1% ) ;放射治疗后鼻窦炎发生率为 86 8% (40 1/46 2 ) ,鼻咽癌患者放射治疗前后鼻窦炎发生率差异有显著性 (χ2 =5 33 2 1,P <0 0 1)。 4 0 1例患者先后在放射治疗末期、放射治疗后 3个月、6个月、12个月和 18个月出现鼻窦炎症状 ,发生率分别为 10 7% (43/40 1)、13 7%(5 5 /40 1)、5 8 1% (2 33/40 1)、12 0 % (48/40 1)、5 5 % (2 2 /40 1)。分段放射治疗与连续性全程放射治疗后鼻窦炎发生率分别为 35 7% (14 3/40 1)、6 4 3% (2 5 8/40 1)。结论　放射性鼻窦炎发生率较高 ,放射剂量对其发生率有较大影响 ,与鼻咽肿瘤浸润范围无关。     

鼻咽癌放疗后大出血的诊治

目的探讨鼻咽癌放疗后大出血的诊治方法及治疗结果。方法收集2011年1月~2015年12月诊治的7例鼻咽癌放疗后大出血患者,分析其临床特点、各种诊治方法的特点及疗效。结果7例鼻咽癌放疗后大出血患者,治愈出院2例,转院行颈内动脉栓塞1例,已治愈。住院期间死亡3例,1例自动出院后死亡。结论鼻咽癌放疗后大出血积极的检查明确出血原因及部位,针对出血原因及部位可采取治疗措施,包括预防性气管切开,不得已情况下的长时间填塞及颈内动脉栓塞,能够有效降低鼻咽癌放疗后鼻出血的死亡率。     

Modified radical neck dissection for residual neck disease after radiotherapy of nasopharyngeal carcinoma

Objective

Although radical neck dissection is proposed as a standard salvage procedure for the management of radiotherapy-resistant nasopharyngeal carcinoma of the neck, modified radical neck dissection may be appropriate for select patients. This study was designed to evaluate the efficacy of individualized neck dissections based on preoperative imaging studies and intraoperative exploration for the management of radiotherapy-resistant nasopharyngeal carcinoma of the neck.

Methods

The study included 42 consecutive patients who failed radiotherapy or chemo-radiotherapy for nasopharyngeal carcinoma of the neck and underwent a total of 46 radical neck dissections or modified radical neck dissections. Selection of the proper type of neck dissection was based on preoperative imaging studies and intraoperative exploration. The patients’ clinical features, pathologic characteristics, complications, and treatment outcome were estimated and analyzed.

Results

Radical neck dissection and modified radical neck dissection were performed on 19 and 27 necks, respectively. Thirty-three necks (71.7%) had multiple node metastases. Nineteen necks (41.3%) had node metastases at two or more levels. The overall morbidity rate was 11.9%. The 5-year neck control rate (NCR) was 79.1% for 46 necks. The 5-year overall survival and disease free survival for 42 patients were 58.0% and 44.0%, respectively. No statistically significant differences were found in comparing OS, DFS, NCR between the MRND and RND groups.

Conclusions

Individualized neck dissection based on preoperative imaging studies and intraoperative exploration is appropriate for the management of radiotherapy-resistant nasopharyngeal carcinoma of the neck.     

鼻咽癌放疗后常见并发症的发病机制与康复评定及治疗进展

鼻咽癌大部分发生在我国华南地区,其中广东和广西地区最常见。放射治疗是鼻咽癌的首选治疗方法。鼻咽癌放疗后晚期常出现多种并发症,如吞咽障碍、张口困难、构音障碍、颈部活动障碍、心理障碍等,严重影响患者的生活质量。康复是治疗鼻咽癌放疗后并发症的有效手段,可以控制并发症的发展或加重并预防新的并发症的出现。鼻咽癌放疗后不同的并发症,其发病机制不同,需要进行康复评定,有针对性地选择不一样的康复治疗方法。本文就鼻咽癌放疗后常见并发症的发病机制、康复评定和治疗进展进行综述,以期为鼻咽癌放疗后并发症康复治疗的开展提供理论依据。     

鼻咽癌治疗后鼻窦炎鼻内镜手术前后处理与疗效

目的探讨提高鼻咽癌治疗后鼻窦炎鼻内镜手术前、后疗效的方法。方法回顾性分析2006年4月～2009年10月共36例鼻咽癌治疗后鼻窦炎患者,鼻内镜手术治疗情况和随访结果,分析其与疗效的关系。结果随访10～36个月,28例治愈,治愈率77.8%;4例好转,好转率11.1%;4例无效,无效率11.1%。总有效率为88.9%。术后并发症主要为鼻腔粘连。结论鼻咽癌治疗后鼻窦炎手术前、后合理用药,恰当的术后处理能提高疗效,有利于提高鼻咽癌患者放疗后的生活质量。     

国内鼻咽癌放疗后耳鼻咽喉并发症的现状与思考

放射治疗是目前治疗鼻咽癌的首选方法,随着放疗技术的进步和综合治疗手段的应用,患者的生存率得以持续提高。但放疗对鼻咽癌患者造成的并发症广泛而持久,严重影响放疗后患者的生存质量。这些并发症主要分布在耳鼻咽喉头颈外科,由于种种原因,鼻咽癌放疗后并发症长期以来并没有得到相应的重视,而且有关注下降之虞。目前鼻咽癌的诊治流程、对鼻咽癌治疗的准入（包括对医院和医生的准入）要求、对鼻咽癌放疗后并发症治疗价值的认识等可能是影响因素。我们应该用生物心理社会医学模式指导临床医疗工作,正确认识疾病与生命的关系,重视生命的质量     

鼻咽癌放/化疗后吞咽障碍的临床评估

目的 遴选出安全、有效、便捷的鼻咽癌放/化疗后吞咽障碍的评估方法。方法 选取在邵阳市中心医院就诊的鼻咽癌患者37例,应用吞咽X线荧光透视检查（VFSS）、进食评估问卷调查量表（EAT-10）、安德森吞咽障碍量表（MDADI）、反复唾液吞咽试验（RSST）和洼田饮水试验（WST）对入组患者进行吞咽功能的评估,筛选适合鼻咽癌放/化疗后吞咽障碍评估的方法。结果 以VFSS为金标准,进食评估EAT-10的灵敏度为83.33%,MDADI灵敏度为72.22%,RSST特异度为84.21%,但这些方法与金标准的Kappa值都小于0.2,其一致性较低。WST特异度为78.95%,Kappa值大于0.2,具有相对较好的一致性。结论 WST与VFSS的一致性相对较好,可以作为鼻咽癌放/化疗后吞咽障碍的筛查工具,其他方法也可辅助评估。     

鼻咽癌自然远处转移与放疗后远处转移的对比分析

目的：探讨鼻咽癌远处转移发生的时间规律。方法：对确诊后未经根治性治疗即已远处转移的患者（自然转移组）103例及放疗开始后出现远处转移的患者（放疗后转移组）138例的临床资料及远处转移发生的时间进行对比分析。结果：自然转移组从首发症状至发生远处转移的时间平均为10．78个月（95％CI：8．68～12．88个月）,放疗后转移组为20．77个月,其差异有统计学意义（P〈0．01）;自然转移组远处转移发生于2年内者占91．26％,而放疗后转移组至第4年才达到93．48％;自然转移组1、2年内发生远处转移比放疗后转移组分别高34．41％和28．94％;自然转移组远处转移100％发生于5年内,放疗后转移组远处转移有2．9％超过5年。自然转移组和放疗后转移组患者的性别、首发症状发生率,差异无统计学意义（P〉0．05）,但放疗后转移组患者年龄偏小,T、N分期偏早（P〈0．05）。结论：放疗后转移者发生远处转移的时间比未经放疗而自然转移者至少推迟1～2年,可能与患者年龄偏小、病期偏早有关。     

放疗对鼻咽癌患者嗅觉的影响

目的 :探讨放疗对鼻咽癌 (NPC)患者嗅觉的影响。方法 :对 10 0例 NPC患者于放疗前、后 3和 6个月 ,1、2、3年 ,分别进行嗅觉检测 ,比较其变化。结果 :与放疗前比较 ,放疗后 3个月患者嗅觉锐度明显减退 ;0 .5～1年 ,嗅觉有所改善 ,但未能达到放疗前水平 ,且感觉阈与识别阈出现分离 ;此后 ,再次出现嗅觉锐度减退现象。结论 :放疗可影响 NPC患者嗅觉 ,放疗后患者嗅觉呈波浪式、永久性减退。     

Surgical technique in endoscopic posterior septoplasty for an adult patient with choanal stenosis

The technique in endoscopic posterior septoplasty for the case of a female aged 49 with bilateral choanal stenosis is presented. This female had undergone endoscopic nasal surgery for stenosis twice before the posterior septoplasty. However, restenosis of the choanae had arisen within 2 weeks after each surgery. This patient underwent the endoscopic posterior septoplasty under general anesthesia. After removal of the cartilage and bony structures of the nasal septum, the posterior one-third of bilateral septal membranes was excised. This technique is to enlarge the choanal opening obliquely. Excellent visualization for the septoplasty using the endoscope was obtained. Sufficient patency of the choanae was achieved using this technique. There still is no restenosis of the choanae observed and the rhinomanometry shows extreme decrease of nasal airway resistance 1 year after this surgery. It is considered that endoscopic posterior septoplasty for choanal stenosis is an effective procedure with low morbidity and long-term patency.     

Diagnosis and management of skull base osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma

OBJECTIVE: The objective of this study was to investigate the diagnosis and management of skull base osteoradionecrosis (ORN) after radiotherapy for nasopharyngeal carcinoma (NPC). METHODS: The general information, clinical manifestations, and treatment outcomes were retrospectively evaluated in 15 patients with skull base ORN after radiotherapy for NPC. RESULTS: The common symptoms of skull base ORN included foul odor, headache, and epistaxis. Endoscopic examination showed exposed bone or sequestration in the nasopharynx. The characteristic findings according to computed tomography included the following: bone was destroyed extensively and symmetrically or regionally; bone was exposed to the air cavity; sequestration can be observed; and small air bladder was present in the parenchyma. There were nine patients regional skull base ORN receiving surgery, two of whom died of postradiation temporal lobe necrosis and seven of whom survived for 2 to 7 years. Conservative treatments were provided to six patients, including five patients with extensive skull base ORN and one patient with regional ORN, among which three patients died of nasopharyngeal bleeding, one patient died of exhaustion, and two patients survived for 3 to 5 years. CONCLUSIONS: Clinical diagnosis of skull base ORN was based on symptoms, computed tomography, or magnetic resonance imaging and endoscopy. The final confirmation was according to pathologic examination. Surgery had the best effect. Extensive ORN accompanied by radiation brain damage or cranial nerves damage had poor prognosis. Nasopharyngeal bleeding and exhaustion were the main causes of death.     

鼻咽癌放疗后分泌性中耳炎的治疗探索

目的探索鼻咽癌（nasopharyngeal carcinoma,NPC）放射治疗后分泌性中耳炎（secretory otitis media,SOM）的治疗方法。方法对63例（72耳）NPC放疗后SOM患者,采用综合治疗措施：全身和局部抗炎,神经营养,扩张血管,激素治疗;加强鼻腔、鼻咽局部清理,治疗鼻腔鼻窦疾病;咽鼓管置管、冲洗并向鼓室注入麻黄碱、氧氟沙星、地塞米松和α-糜蛋白酶混合药液。结果所有患者治疗前均有耳鸣、耳闷塞感、听力下降等症状,鼓室导抗图均为“B”型。经综合治疗后,耳鸣消失45耳（62.50％）,好转17耳（23.61％）,无效10耳（13.89％）,总有效率86.11％;耳闷塞感消失57耳（79.17％）,好转11耳（15.28％）,无效4耳（5.55％）,总有效率94.45％;声阻抗检查鼓室曲线“A”型38耳（52.78％）,“As”型25耳（34.72％）,“B”型4耳（5.56％）,“C”型5耳（6.94％）;0.5、1.0、2.0kHz气导听阈均值从治疗前的（46.0&#177;5.0）dBHL提高到治疗后的（25.8&#177;3.5）dBHL,差异具有显著性（P〈0.001）。结论分析NPC放疗后SOM的发病机理,有针对性地采取对因治疗,是非常有效和切实可行的,对提高NPC患者的生存质量具有重要意义,可以在临床实践中加以应用和推广。