27例鼻咽癌患者合并分泌性中耳炎的临床分析

目的探讨鼻咽癌患者放疗前后分泌性中耳炎的临床特点及治疗措施。方法回顾性分析2003年一2006年我院经治的27例鼻咽癌患者,将其放疗前、放疗后的情况进行回顾分析。21例（32耳）中耳炎患者被分为鼓膜穿刺组与鼓膜置管组。结果27例患者放疗前有14例（17耳）并发分泌性中耳炎,放疗后分泌性中耳炎的患者增至21例（32耳）,双耳发病11例,6例未发生分泌性中耳炎。鼓膜穿刺组12例（19耳）,显效率为78.9％（15／19）,1例患者发展为慢性化脓性中耳炎;置管组9例（13耳）,有5例（7耳）疗效显著,显效率为54％（7／13）,有2例患者鼓膜穿孔。MRI检查显示,21例分泌性中耳炎患者中,19例有明显咽鼓管挤压和腭帆张肌肿胀。结论MRI检查有助于鼻咽癌患者放疗前后并发分泌性中耳炎的评估;鼓膜穿刺抽吸是治疗鼻咽癌并发分泌性中耳炎的有效和实用的措施。     

鼻咽癌患者放疗前后并发分泌性中耳炎的临床观察

目的 分析鼻咽癌患者放疗前后分泌性中耳炎（secretory oddsmedia，SOM）的发病情况，以探讨鼻咽癌放疗前后并发分泌性中耳炎的发病机制。方法 选取1999年7月-2000年11月在中山大学附属第二医院确诊为鼻咽癌并接受放疗的58例患者，将其放疗前、放疗中、放疗结束时、放疗后3个月、6个月、9个月、一年时并发SOM的情况进行分析和统计。结果 58例患者放疗前有33例并发分泌性中耳炎，其中双耳8例；放疗后分泌性中耳炎的患者44例，其中双耳18例。放疗前后均未发生分泌性中耳炎者14例。鼻咽癌患者各个T分期（除T3外）放疗后合并分泌性中耳炎的发生率显著增加，差异有统计学意义（P〈0．01），即随放疗后时间延长有逐渐增加的趋势。放疗后3个月动态变化最大，放疗后6个月-1年分泌性中耳炎发病较平稳。结论 鼻咽癌患者鼻咽部机械性阻塞、腭帆张肌功能异常、咽鼓管功能不良和咽鼓管位置异常是放疗前合并分泌性中耳炎的重要原因；放疗后合并分泌性中耳炎的机制是多因素的。     

鼻咽癌放疗后并发分泌性中耳炎的临床分析

目的探讨鼻咽癌患者放射治疗后分泌性中耳炎的临床特点。方法对蚌埠医学院第一附属医院2007~2010年127例有完整资料鼻咽癌患者总结放疗后分泌性中耳炎的发生情况并分析其影响因素。结果127例患者中放疗后116例发生分泌性中耳炎,分泌性中耳炎发生率为91.3%（116/127）;放疗后3个月、6个月、12个月及18个月分泌性中耳炎的发生率分别为11.8%（15/127）、29.1%（37/127）、46.5%（59/127）及3.9%（5/127）,差异有统计学意义(χ2=71.23,P<0.001)。中晚期患者( T3+T4)放疗后分泌性中耳炎发生率为96.2%（76/79）,而早期患者( T1+T2)为83.3%（40/48）,两者差异有统计学意义(χ2=4.73, P＝0.030);鼻咽照射剂量≤70Gy的患者,放疗后分泌性中耳炎发生率为86.5%（64/74）,当鼻咽照射剂量>70Gy的患者,分泌性中耳炎的发生率为98.1%(52/53),两者比较差异具有统计学意义(χ2=3.91,P＝0.048);当咽鼓管咽口被侵犯后放疗后分泌性中耳炎发生率为98.2%（56/57）,而未向咽鼓管咽口侵犯的鼻咽癌放疗后分泌性中耳炎的发生率为85.7%（60/70）,两者比较差异具有统计学意义(χ2=4.75,P＝0.029)。结论鼻咽癌患者放疗后分泌性中耳炎的发生率较高,在放疗后12个月达最高峰;咽鼓管咽口有无侵犯、鼻咽照射剂量和T分期与放疗后分泌性中耳炎的发生有关。     

鼻咽癌放疗前后腭帆张肌横截面积的改变与放射性中耳炎的相关性

目的 探讨鼻咽癌放疗前后腭帆张肌横截面积的改变与放射性中耳炎的相关性。方法 回顾性分析苏州市吴江区第一人民医院2007年1月至2011年1月就诊的36例接受放射性治疗的鼻咽癌患者的临床资料,于放疗前后分别测量所有患者上腭帆张肌及翼内肌的横截面积,比较放疗前后的差异,并分析患者于放疗后发生放射性中耳炎与腭帆张肌受损之间的相关性。结果 放疗后共24例(44耳)并发分泌性中耳炎;放疗后STVP、SLTVP、SRTVP、SLTVPM、SRTVPM、SLTVPF、SRTVPF、SMP、SLMP及SRMP与放疗前相比明显下降(P<0.05);腭帆张肌萎缩耳中分泌性中耳炎的发生率明显高于腭帆张肌无萎缩耳者(72.92% vs 37.50%, χ2=8.445, P=0.004)。结论 放疗后鼻咽癌患者的腭帆张肌与翼内肌会发生萎缩,而放疗后分泌性中耳炎的发生与腭帆张肌的萎缩可能有一定的相关性。     

鼻咽癌放疗后分泌性中耳炎的疗效评价

目的 寻找鼻咽癌放疗后分泌性中耳炎的有效治疗方法，以提高鼻咽癌患者放疗后的生存质量。方法 对鼻咽癌放疗后并发分泌性中耳炎的患者行鼓膜穿刺抽液、鼻腔鼻咽部清理及冲洗，随访半年后评价疗效。结果 在治疗鼻咽癌放疗后分泌性中耳炎的患者时，行鼓膜穿刺加鼻腔鼻咽部清洗疗效较佳。结论 对鼻咽癌放疗后分泌性中耳炎的治疗需要综合疗法。     

鼻咽癌放射治疗后分泌性中耳炎及其治疗方法的探讨

鼻咽癌放射治疗后分泌性中耳炎的发生是目前临床放射治疗中一个难以避免的问题.放射治疗引起的分泌性中耳炎导致听力下降,严重影响影响病人的生活质量,是目前临床治疗的难题.为深入了解鼻咽癌放射治疗后分泌性中耳炎的发生规律,并探讨有效的治疗方法,我们观察了53例鼻咽癌放疗后分泌性中耳炎的发生情况以及鼓室置管治疗鼻咽癌放疗后分泌性中耳炎的疗效,现报道如下.     

鼻咽癌并发的分泌性中耳炎治疗方法的研究

目的:探讨鼻咽癌并发的分泌性中耳炎的治疗方法。方法:将58例鼻咽癌放疗前并发分泌性中耳炎患者随机分为两组。A组:鼻腔鼻咽部清理及冲洗加鼓膜穿刺抽液;B组:鼓膜切开或鼓室置管引流。随访半年,对治疗分泌性中耳炎的有效率和并发症发生率进行比较。结果:随访半年后,58例中存活51例。存活患者中,治疗分泌性中耳炎的有效率A组为82.1％,B组为57.1％,差异有显著性意义(P<0.05);治疗分泌性中耳炎并发症发生率A组为3.6％,B组为28.6％,差异有显著性意义(P<0.05)。结论:鼻咽癌患者分泌性中耳炎的治疗,鼻腔鼻咽部清理及冲洗加鼓膜穿刺抽液优于鼓膜切开或鼓室置管引流。     

早期干预在减缓鼻咽癌放疗后分泌性中耳炎中的作用

目的探讨鼻咽癌患者放疗早期经鼓室注入曲安奈德及氨溴索溶液在减缓放疗后分泌性中耳炎中的作用。方法收集在放疗前无分泌性中耳炎症状的鼻咽癌患者40例,共有64耳在放射野内,分为实验组和对照组各32耳。实验组于放疗量达30Gy开始每周鼓室注射曲安奈德及氨溴索混合液,对照组不进行任何预防性处理,直到放疗结束,两组病人均观察至放疗结束后6个月,比较分析两组病人在放疗结束,放疗后第3个月末及第6个月末患分泌性中耳炎的概率。结果放疗结束时实验组1人1耳出现分泌性中耳炎(1/32),对照组有4人6耳出现分泌性中耳炎(6/32),两者差异有统计学意义(X2=18.19,p<0.01)。放疗后第3个月末实验组有2人2耳出现分泌性中耳炎(2/32),对照组中有6人共9耳出现分泌性中耳炎(9/32),两者差异有统计学意义(X2=20.75,p<0.01)。第6个月末时实验组有4人共6耳出现分泌性中耳炎(6/32),对照组共有13人共18耳出现分泌性中耳炎(18/32),两者差异有统计学意义(X2=30.47,p<0.01)。结论在鼻咽癌放疗早期经鼓室注入曲安奈德及氨溴索,能减缓鼻咽癌患者放疗后分泌性中耳炎进程。     

螺旋CT中耳三维内窥镜重建

我们应用螺旋ＣＴ对１４例（１６耳）中耳疾患患者行中耳螺旋ＣＴ扫描,分别行计算机骨三维重建和内窥镜三维重建。６例（７耳）患者行鼓室探查术。一、材料与方法男９例,女５例。年龄２３～５２岁。其中分泌性中耳炎３例、中耳外伤２例（其中１例继发中耳感染）、胆脂瘤型中耳炎１例、慢性化脓性中耳炎８例（１０耳）。全部患者均行双耳螺旋ＣＴ扫描,分别行骨三维重建和内窥镜三维重建。使用ＣＴ装置为美国ＧＥ公司生产ＨｉｓｐｅｅｄＣＴ／ｉ型扫描机。扫描条件：层厚１ｍｍ、螺距为１,扫描层数±２０层,行螺旋扫描。原始数据重建：０…     

鼻咽癌放疗后10年咽鼓管功能随访

该文作者对３４例鼻咽癌（ＮＰＣ）病人放疗前后的咽鼓管功能进行研究,分别测试放疗前和放疗后６月、５年、１０年的咽鼓管功能。放疗前咽鼓管功能障碍的原因为咽鼓管功能性损害。所有病人在２月内接受７０～８０Ｇｙ的放疗剂量,６月后咽鼓管功能检测均存在功能性和器质性的障碍。５年后２０例无复发的存活病人中,放疗剂量小于７１Ｇｙ的部分患者咽鼓管功能恢复。作者认为因置管可引起持续性耳漏,ＮＰＣ病人放疗后渗出性中耳炎不需行鼓膜置管。该文报道放疗１０年后,放疗对咽鼓管功能的长期影响。所有患者分别测试咽鼓管开放压、鼓室压…     

Significance of X-ray computed tomography analysis in invasion and lymph node metastasis and TNM classification of nasopharyngeal carcinoma]

From 1986-1990, 100 NPC patients, proved by pathology and CT scan before treatment, were selected for analysis to observe the relationship between CT features and clinical signs of NPC. The common routes of invasion and metastasis of NPC were analysed. Furthermore, advantages of CT on TNM classification of NPC were discussed.     

Postirradiation sinus mucosa disease in nasopharyngeal carcinoma patients

OBJECTIVES/HYPOTHESIS: We sought to determine the incidence, progression, and risk factors for postirradiation sinus mucosa diseases (SMD) incidentally found on follow-up magnetic resonance images MRIs) in nasopharyngeal carcinoma (NPC) patients.STUDY DESIGN: RETROSPECTIVE. METHODS: The medical records, pre- and postradiotherapy (RT) MRIs were reviewed in NPC patients. Lund-Mackay system for staging of rhinosinusitis (Lund score) was used as a tool for investigation. RESULTS: One hundred twelve NPC patients (77 males and 35 females) were recruited in this study. The distribution of tumor staging in these patients were 39 (34.8%) patients in T1,23(20.5%) in T2, 31(27.7%) in T3, and 19 (17.0%) in T4 by MRI staging before RT. In these 62 patients with normal sinus ventilation before RT, 42 (67.7%) patients returned to having SMDs 3 months after RT. The maxillary,anterior ethmoid, and posterior ethmoid sinuses were most readily affected. In patients with SMDs at 3 months postRT, advanced tumor stage (P = .013) and smoking habit (P =.047) were the two factors that significantly influence Lund score. When comparing Lund score with different times after radiation therapy, a trend of decrease in Lund score could be noted from 3 months to 3 years after irradiation.CONCLUSIONS: The incidence and severity of SMD was found to be highest at 3 months postRT and decreased gradually with time. Conservative management with clinical symptom correlation should be attempted first in these patients. In these NPC patients,advanced tumor stage and smoking habit would predispose them to SMD development.     

鼻咽癌放疗前后鼻窦炎发生机制及其防治措施

目的:分析鼻咽癌(NPC)患者放疗前后鼻窦炎发生的影响因素,并探讨防治放疗后继发鼻窦炎的措施和手段。方法:回顾性统计分析231例NPC患者放疗前后发生鼻窦炎的影响因素及部分患者的治疗效果。结果:231例NPC患者中,放疗前98例患有鼻窦炎,放疗后165例发生鼻窦炎,其中T分期较高、鼻腔有解剖变异的患者放疗后鼻窦炎发生率较高,有鼻咽局部治疗的患者鼻窦炎发生率较低,放疗前就有鼻窦炎的患者,绝大部分患者放疗后不仅没有得到改善反而有所加重。结论:放疗前鼻窦炎的发病率随临床分期的加重而递增,窦口鼻道复合体的解剖变异、鼻腔解剖变异仍然是其发生的重要因素。对于放射治疗的NPC患者,T分期较高、解剖变异、鼻咽局部治疗以及放疗状况与放疗后鼻窦炎的发生有关,加强放疗前鼻窦炎的治疗以及放疗中、后期鼻咽局部治疗可减少放疗后鼻窦炎的发生。     

Role of computed tomography imaging in predicting response of nasopharyngeal carcinoma to definitive radiation therapy

PURPOSE: The purpose of this study was to investigate the role of posttreatment computed tomography (CT) scans in assessing response of nasopharyngeal carcinoma (NPC) to definitive radiotherapy. MATERIAL AND METHODS: Between March 1999 and October 2003, a total of 132 consecutive patients with newly diagnosed NPC were studied. Sixty-one patients with AJCC stage I or II NPC were treated with radiation only; 71 patients with stage III or IV disease but no evidence of distant metastasis were treated with concurrent chemoradiotherapy. All patients received CT scans of the head and neck, nasopharyngoscopy, and biopsies of primary sites at 4 to 6 months after completion of radiotherapy. Clinical response of the primary tumor as determined by comparison of pre- and posttreatment CT scans was correlated to pathology results. RESULTS: The median follow-up time for all patients was 25 months (range, 9-40 months). Radiologic progression was seen in five patients, stable disease in 18 patients, and radiographic partial (rPR) and complete responses (rCR) were seen in 67 and 42 patients, respectively, at 4 to 6 months of follow up. Biopsies of the nasopharynx were positive in six patients. For patients with rCR, two patients (4.8%) had positive biopsies. Four patients with residual disease (rPR, stable, or progressive disease) after treatment had positive biopsies. The positive and negative predictive values, sensitivity, and specificity of CT scans in evaluating the NPC response to radiotherapy were 0.04, 0.95, 0.67, and 0.32, respectively. CONCLUSIONS: Pathologic CR for nasopharyngeal carcinoma is usually evident at 4 to 6 months after definitive radiotherapy; however, there is no correlation between pathologic and radiographic response. Although longer follow up is required to define the relationship between radiographic and pathologic responses with respect to disease control, we find CT scan at 4 to 6 months after radiotherapy to be neither sensitive nor specific in predicting the response of primary NPC to radiotherapy.     

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...     

Electrophysiological change in the tensor veli palatini muscle after radiotherapy

Conclusion: Electromyography of the tensor veli palatine (TVP) was abnormal and showed mainly myogenic impairment in patients with nasopharyngeal carcinoma (NPC) with secretory otitis media (SOM) after radiotherapy. The diseased ears showed impairment in opening functions of the eustachian tubes (ETs). Objectives: To characterize electrophysiology of the TVP muscle using electromyography (EMG) in patients with SOM after radiotherapy of NPC. Methods: Twenty healthy volunteers and 20 patients with NPC and SOM after radiotherapy were chosen for assessment of EMG of the TVP during swallowing. Results: The measurements of average duration and amplitude of action potential, swallowing contraction duration, and peak voltage in NPC patients with both SOM (n = 25) and healthy ears (n = 6) were significantly lower than those of ears (n = 38) in healthy controls (p < 0.01). In patients with NPC, the average action potential duration and swallowing contraction duration in ears with SOM were lower than those of subjects with healthy ears (p < 0.05), whereas no significant difference was found in average amplitude of action potential and peak voltage between them.     

鼻内镜下咽鼓管置管治疗鼻咽癌放疗后分泌性中耳炎

目的 探讨鼻内镜下咽鼓管置管治疗鼻咽癌放疗后分泌性中耳炎的临床疗效。方法 对45例(58耳)鼻咽癌放疗后并发分泌性中耳炎者行鼻内镜下经咽鼓管逆行插管并注药治疗。结果45例(58耳)接受鼻内镜下咽鼓管置管治疗,治愈42耳(72.42％),好转13耳(22.41％),无效3耳(5.17％),总有效率94.83％。结论 鼻内镜下咽鼓管置管有利于咽鼓管功能的恢复,是治疗鼻咽癌放疗后分泌性中耳炎的可靠手段。     

咽鼓管置管在治疗鼻咽癌放疗后分泌性中耳炎中的价值

目的：探讨咽鼓管置管治疗鼻咽癌（NPC）放疗后分泌性中耳炎（SOM）的价值。方法：分析鼻内窥镜下经咽鼓管置管治疗106例(112耳) NPC放疗后SOM的疗效。结果：患者接受治疗后,耳鸣消失81耳(72.32%) ,好转 25耳(22.32%), 无效6耳(5.36%) ,总有效率94.64%。耳闷塞感消失 92耳(82.14%) ,好转18耳(16.07%),无效2耳(1.79%),总有效率98.21%。无1例发生耳漏。声阻抗检查：鼓室曲线A型56耳(50.00%),As型42耳(37.50%),B型2耳(1.79%),C型12耳(10.71%)。治疗前后0.5、1.0、2.0?kHz气导听阈均值分别为（47.0±5.0）dBHL和（28.5±3.0）dBHL,两者具有统计学差异(P<0.001)。结论：咽鼓管置管治疗NPC放疗后SOM,对咽鼓管具有一定的支撑作用,能有效地避免耳漏。     

双管置入治疗鼻咽癌放疗后分泌性中耳炎

目的 探讨鼻咽癌放疗后分泌性中耳炎的治疗方法。方法 将60例(88耳)患者随机分为单管组和双管组, 每组30例(44耳)。单管组行常规鼓膜置管,双管组在置管引流的同时,在哑铃管上方置入直管(微)型预防插管,起通气作用。比较分析两组治疗效果及并发症。结果 随访10个月,两组有效率、6个月内堵管发生率相比差异有统计学意义,并发症差异无统计学意义。结论 治疗鼻咽癌放疗后伴发的分泌性中耳炎,双管置入鼓膜引流、通气优于单纯鼓膜置管引流。