摘要
目的：
分析鼻咽癌患者放疗后发生鼻窦炎的影响因素；观察鼻咽癌放疗后继发性鼻窦炎(简称放疗后鼻窦炎，下同)患者鼻腔、鼻窦内菌群的生长情况及粘膜纤毛的形态变化，初步探讨放疗后鼻窦炎的发病机制和影响因素。
方法：
1．用Logisdc回归方法回顾性分析鼻咽癌患者放疗后发生鼻窦炎的影响因素；
2．选取20例放疗后鼻窦炎患者及20例慢性鼻窦炎患者的鼻腔、鼻窦分泌物做细菌培养及药敏实验；
3．用扫描电镜观察10例放疗后鼻窦炎患者的鼻窦粘膜纤毛的超微形态。
结果：
1．153例鼻咽癌患者放疗后有66例发生了放疗后鼻窦炎；
2．放疗后鼻窦炎患者的菌群生长与慢性鼻窦炎患者有明显差异；
3．放疗后鼻窦炎患者的鼻窦、鼻腔粘膜纤毛系统遭严重破坏，纤毛严重坏死、脱落。
结论：
放射线照射引起鼻腔、鼻窦粘膜纤毛坏死、脱落是引起放疗后鼻窦炎的主要原因；细菌感染对放射线有协同作用；对于鼻咽癌患者，T分期高、鼻腔侵犯是发生放疗后鼻窦炎的危险因素，而鼻咽冲洗是保护因素。因此，尽量减少鼻咽癌患者鼻腔、鼻窦受照射面积、保护鼻腔、鼻窦粘膜、控制细菌感染及常规鼻咽冲洗是避免或减少放疗后鼻窦炎发生的有效措施。
Purpose:
To evaluate the risk factors of nasosinusitis after radiotherapy of nasopharyngeal carcinoma(NPC); observe the growth condition of bacteria inside the nasal cavity and nasosinus; and observe the ultrastructure/microstructure of naso-cilia in patients who had suffered from nasosinusitis after radiotherapy. Primarily to learn the pathogenesis of nasosinusitis after radiation. Methods:
1. From January 1990 to December 2001,153 NPC patients without nasosinusitis before radiotherapy were retrospectively analysed;
2. 20 cases of nasosinusitis after radiation as trial group and 20cases of chronic sinusitis were selected as control group, compare with the bacteriological examination between two groups.
3. To observe the nasal and paranasal mucosa in 10 patients with nasosinusitis after radiation by scanning electron microscope (SEM).
Results:
1. 66 patients had suffered from nasosinusitis after radiotherapy;
2. There is a significant difference between trial group and control group in bacteriology examination.
3. The mucociliary microstructure had destyoied even fall off in
patients with nasosinusitis after radiotherapy. Conclusion:
The mechanism of nasosinusitis after radiation is cilia of mucosa inside nasal and paranasal was destroyed after irradiation; bacteria is not an important reason in nasosinusitis afer radiation and it cooperate with irradiation to aggravate sinusitis possibly; high T stage and nasal cavity infringement are the risk factors of nasosinusis after radiotherapy of nasopharyngeal carcinoma(NPC), on the other hand, nasopharyngeal cavity flush is the protect factor.
引文
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