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目的:探讨鼻咽癌放疗后颞骨放射性骨坏死的诊断和治疗。方法:21例(22耳)鼻咽癌放疗后颞骨放射性骨坏死患者,经耳镜及影像学检查16例17耳局限型,5例5耳弥漫型。17耳局限型及1耳弥漫型予耳内镜下死骨刮除术,4耳弥漫型行乳突根治加耳周带蒂筋膜转移填塞术。结果:局限型17耳中,12耳(70.6%)创面完全上皮化,无游离死骨形成而治愈;4耳(23.5%)好转,创面未完全上皮化,但随访无死骨形成;1耳(5.9%)未愈,呈进行性死骨发展。弥漫型5耳中,1耳行有限度的死骨刮除术,创面完全上皮化而治愈;乳突根治4耳中,治愈3耳,1耳死骨形成再次手术,仍有耳漏。结论:耳内镜及颞骨CT为该病提供不同特点的诊断价值,对局限型行局部死骨刮除术能获得较好的疗效,提高患者的生活质量;弥漫型手术选择应慎重,本病有进行性缓慢发展的可能,需定期随访。
Objective: To investigate the diagnosis and treatment of radioactive osteonecrosis of temporal bone after radiotherapy of nasopharyngeal carcinoma. METHODS: Twenty-one patients (22 ears) with temporal bone necrosis after nasopharyngeal carcinoma radiotherapy were examined by otoscopy and radiology. Sixteen cases of 17-ear confinement and 5 cases of diffuse five-ears were examined. 17 ears limited and 1 diffuse ear to the endoscopic resection of the sequestrum, 4 diffuse mastoid omnidirectional pedicle and pedicle fascia transfer stuffing. Results: In the limited 17 ears, 12 ears (70.6%) were completely epithelialized without any formation of free sequestrum and cured. Four ears (23.5%) improved and the wound was not completely epithelized, but there was no sequestration at the follow- (5.9%) did not heal, showing the development of the sequestrum. Diffuse 5 ears, 1 ear line of limited sequestrum, wound completely epithelialized and cured; mastodendron 4 ears, 3 ears, 1 ear sequestrum formation reoperation, there are still ear leaks. Conclusion: Endoscopic and temporal bone CT provide different diagnostic value for the disease, and can achieve better curative effect on limited type of local craniofacial curettage and improve the quality of life of patients. Diffuse operation should be carefully selected, and the disease Progressive slow development may require regular follow-up.