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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。
BACKGROUND & OBJECTIVE: Nasopharyngeal necrosis is a special radiotherapy sequelae after radiotherapy of nasopharyngeal carcinoma. In the past, more conservative treatment was used, and the curative effect was poor. In this study, nasopharyngeal endoscopic nasopharyngeal debridement for the treatment of nasopharyngeal necrosis, aimed to explore a new method for the treatment of nasopharyngeal necrosis. Methods: Twenty patients with nasopharyngeal necrosis after radiotherapy of nasopharyngeal carcinoma admitted to Sun Yat-sen University Cancer Hospital from June 2006 to March 2007 underwent endoscopic debridement under endoscopic sinus surgery. According to the nasopharyngeal necrosis bacteria Sensitivity and susceptibility test results of the selection of sensitive antibiotics for anti-infective treatment, summarizes the short-term efficacy. Results: In 20 cases, 5 cases of nasopharyngeal necrosis were completely repaired, and 12 cases of clinical symptoms such as headache, nose odor and repeated bleeding were improved to varying degrees; 3 cases of severe nasopharyngeal patients after treatment although the clinical symptoms were relieved, However, within 1 year after the occurrence of nasopharyngeal hemorrhage death due to nasopharyngeal bleeding. Conclusion: Endoscopic nasopharyngeal debridement is an effective method for the treatment of nasopharyngeal necrosis of nasopharyngeal carcinoma after radiotherapy. However, the nasopharyngeal necrosis is serious, and the prognosis of the large vessel involved is poor.