内镜下鼻咽清创术治疗鼻咽癌放疗后鼻咽坏死20例近期疗效

背景与目的:鼻咽坏死是鼻咽癌放疗后一种较为特殊的放疗后遗症,既往多采用保守治疗,疗效欠佳.本研究采用经鼻内镜鼻咽清创术治疗鼻咽坏死,旨在探讨对鼻咽坏死处理的新方法.方法:对2006年6月至2007年3月中山大学肿瘤医院收治的20例鼻咽癌放疗后鼻咽坏死患者在鼻内镜直视下进行局部清创治疗,并根据鼻咽坏死物的细菌培养和药敏试验结果选择敏感抗生素进行抗感染治疗,总结其近期疗效.结果:20例患者中5例鼻咽坏死完全修复,12例临床症状如头痛、鼻臭及反复出血等症状均得到不同程度改善;3例鼻咽坏死严重患者经治疗后临床症状虽有缓解,但在出现鼻咽坏死后1年内因鼻咽大出血死亡.结论:经鼻内镜鼻咽清创术是治疗鼻咽癌放疗后鼻咽坏死的一种有效手段,但鼻咽坏死严重,累及大血管者预后较差.

Short-term efficacy of endoscopy-guided debridement on radiation-related nasopharyngeal necrosis in 20 nasopharyngeal carcinoma patients after radiotherapy

BACKGROUND & OBJECTIVE: Nasopharyngeal necrosis is an unusual sequelae after radiotherapy for nasopharyngeal carcinoma (NPC). It is mostly managed by conservative treatment, but the efficacy is unsatisfied. This study was to investigate the efficacy of endoscopy-guided debridement on irradiation-related nasopharyngeal necrosis in NPC patients after radiotherapy. METHODS: Between Jul. 2006 and Mar. 2007, 20 NPC patients with irradiation-related nasopharyngeal necrosis after radiotherapy were treated with endoscopy-guided debridement and systemic anti-inflammatory treatment in Cancer Center of Sun Yat-sen University. The short-term outcomes were analyzed. RESULTES: Nasopharyngeal necrosis was cured in 5 patients. Clinical symptoms such as foul odor, headache, and hemorrhage were alleviated in 12 patients. Three patients died of nasopharyngeal massive hemorrhage within 1 year although their clinical symptoms were alleviated. CONCLUSION: Endoscopy-guided debridement is effective in treating irradiation-related nasopharyngeal necrosis, but the prognosis of the NPC patients with severe nasopharyngeal necrosis and internal carotid artery involvement is relatively poor.