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目的 探讨鼻咽癌(NPC)放射治疗的眼部并发症,提高患者生存质量。方法 对254例NPC住院首程放射治疗患者在放射治疗前、中及后观察其视功能改变,包括远视力、裂隙灯显微镜、眼底、自动电脑视野及视诱发电位检查。视网膜损伤分级参照国际放射治疗晚期并发症(视网膜损伤)评分标准。结果 241例患者照射剂量≥70Gy,发生视网膜损伤22例。观察时间30～61个月,平均46.8±14.4个月。发现视网膜损伤后早期进行治疗的9例患者病情获得控制,7例接受治疗较晚的患者,以后均发生视神经病变;其中3例患者在发生视网膜病变以后,观察14～20个月发现放射性脑病。NPC放射治疗性视网膜病变与患者年龄之间,差异无显著性意义(P>0.05)。照射剂量在75～79 Gy组视网膜损伤发生率明显比70～74 Gy组高,差异有显著性意义(13.6％:5.6％,x~2=4.54,P<0.05)。结论 NPC放射治疗性视网膜病变与照射剂量和患者对射线的个体敏感性差异有关。NPC放射治疗后发生视网膜病变,提示视神经及脑组织可能已受损害,应及时做头颅CT或MRI及其他相关检查,对放射性脑病的早期发现可能有一定意义。发生视网膜损伤应及早发现并积极进行中西医结合治疗,对其视功能保护以及提高生存质量有积极意义。
Objective To investigate the ocular complications of radiotherapy for nasopharyngeal carcinoma (NPC) and improve the quality of life of patients. Methods 254 patients with NPC first-line radiotherapy were observed before, during and after radiotherapy, including visual function changes, including far vision, slit lamp microscope, fundus, automatic computer vision and visual evoked potentials. Retinal damage classification with reference to international advanced radiological complications (retinal damage) score standards. Results 241 patients irradiated dose ≥ 70Gy, retinal injury occurred in 22 cases. The observation time was 30 to 61 months with an average of 46.8 ± 14.4 months. Nine patients who were treated early after retinal injury were found to be in control of the disease and seven of the patients who were treated later had optic neuropathy. Three of the patients were found to have a radiation encephalopathy 14 to 20 months after the occurrence of the retinopathy. There was no significant difference between radiotherapy-induced retinopathy and patient’s age (P> 0.05). The incidence of retinal damage was significantly higher in the 75-79 Gy group than in the 70-74 Gy group (13.6% vs 5.6%, x ~ 2 = 4.54, P <0.05). Conclusions The radiotherapy-induced retinopathy of NPC is related to the dose of irradiation and the individual sensitivity of the patient to radiation. NPC radiotherapy retinopathy, suggesting that the optic nerve and brain tissue may have been damaged, head CT or MRI should be done in time and other related tests, early detection of radioactive encephalopathy may have some significance. Occurred retinal damage should be detected as early as possible and active treatment of Integrative Medicine, its visual function protection and improve the quality of life has a positive meaning.