鼻咽癌放射治疗后鼻黏膜形态学变化与鼻窦炎发生的关系

目的 从鼻黏膜组织形态学角度探讨鼻咽癌患者放疗后并发鼻窦炎的原因.方法 按病例纳入和剔除条件选出74例初诊鼻咽癌患者作为研究对象.于放疗前和治疗结束后3 d内各取同侧中鼻甲黏膜组织一块,在光镜下观察黏膜组织形态;随访1年以上,根据病史、鼻内窥镜检、鼻窦CT检查结果观察鼻窦炎发病情况;根据鼻黏膜组织形态改变和鼻窦炎发病情况进行分析.结果 (1)74例鼻咽癌病人放疗后,有68例病人鼻黏膜组织形态出现不同程度的损伤,如放疗前鼻黏膜组织形态异常,则放疗后其损伤更为严重.(2)随访1年以上,74例初诊鼻咽癌患者中有63例并发鼻窦炎,占85.14%,其中,Ⅰ型1期9例、Ⅰ型2期54例.(3)放疗前,鼻黏膜组织形态正常50例,异常24例,放疗后的鼻窦炎发病率分别为82%、91.67%(P>0.05);放疗后,鼻黏膜组织形态损伤和正常者的鼻窦炎发病率分别为89.71%、33.33%(P<0.05).结论 放疗对鼻咽癌患者的鼻黏膜有明显的损伤作用;鼻黏膜放射性损伤是鼻咽癌患者放疗后并发鼻窦炎的主要原因.

Relationship between the histomorphological changes of the nasal mucosa and nasosinusitis in nasopharyngeal carcinoma patients after radiotherapy

Objective To explore the causation of nasosinusitis in the nasopharyngeal carcinoma(NPC)patients after radiotherapy by the histomorphology of the nasal mucosa.Methods Seventy four specimens from the nasal mucosa of NPC patients after radiotherapy were selected.Observed the mucosal histomorphology before and after radiotherapy under light microscope.The patients were followed up more than one year,including history,CT and endoscopic sinus examination.Results(1)Seventy four specimens,68 specimens were found destruction of different degree in the nasal mucosa.(2)Forllow up was conducted more than one year,63 of 74 specimens had nasosinusitis(85.14%).(3)Before radiotherapy the normal and abnormal nasal mucosa was 50 and 24 cases,and the incidence of nasosinusitis was 82% and 91.67%(P>0.05)after radiotherapy,respectively.The incidence of nasosinusitis was 33.33% and 89.71%(P<0.05)in the normal and damaged nasal mucosa after radiotherapy,respectively.Conclusion We found radiotherapy can damage the nasal mucosa,it may be the uppermost causation of nasosinusitis in NPC patients after radiotherapy.