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目的分析手术治疗鼻咽癌放射性脑损伤的原因、特点和预防。方法鼻咽癌放射治疗后造成放射性脑损伤的60例患者,回顾性分析患者发生脑损伤与放射治疗的方法、放射剂量、耳前野上界以及颈部纤维化之间的关系情况。结果 60例患者中单侧脑损伤45例,双侧脑损伤15例,发生在颞叶的脑损伤有48例,通过CT增强扫描发现脑损伤一侧出现血管扩张的有37例。所有患者在首程放疗后出现脑损伤50例,原发性病灶又复发的行再程放射10例,首程出现的患者耳前野上界颅底基底线上1、2、3 cm处分别有28例、10例、7例。再程放疗后患者距离首程放疗时间8~116个月,平均时间(53.2±4.3)个月。结论脑供血不足或者出现血管损伤是鼻咽癌放射性脑损伤的基础,使用面颈联合野,并适当降低耳前野上界治疗能有效降低放射性脑损伤的发生率。
Objective To analyze the causes, characteristics and prevention of radiation-induced brain injury in nasopharyngeal carcinoma treated by surgery. Methods Sixty patients with radiation-induced brain injury after radiotherapy of nasopharyngeal carcinoma were retrospectively analyzed. The relationship between brain injury and radiotherapy, radiation dose, upper ear field and neck fibrosis were retrospectively analyzed. Results Among the 60 patients, there were 45 cases of unilateral brain injury, 15 cases of bilateral brain injury and 48 cases of brain injury in temporal lobe. Thirty-seven cases of vasodilation were found on the side of brain injury by CT enhanced scan. All patients had brain injury in the first stroke after radiotherapy in 50 cases, recurrent primary recurrence of radiation in 10 cases, the first occurrence of the first half of the anterior superior genu region of the basal fundus of the base line at 1, 2, 3 cm were 28 cases, 10 cases, 7 cases. Radiotherapy after radiotherapy patients from the first radiotherapy time of 8 to 116 months, the average time (53.2 ± 4.3) months. Conclusions Cerebral insufficiency or vascular injury is the basis of radioactive brain injury in nasopharyngeal carcinoma. The use of facial and cervical joint field and proper reduction of the upper ear field can effectively reduce the incidence of radiation-induced brain injury.