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 (magneticresonanceimaging ,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.