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目的分析鼻咽癌放疗后继发慢性鼻窦炎的临床特征。方法对2011年1月至2013年5月来我科门诊及住院治疗的放疗致慢性鼻窦炎患者(放疗组)及单纯慢性鼻窦炎患者(对照组)各40例行视觉模拟评分法(VAS)评价鼻部主观症状、鼻内镜检查、鼻窦CT检查,并给予相应评分。放疗组中15例及对照组中36例接受鼻内镜鼻窦手术,术中行上颌窦穿刺,抽取脓性分泌物行细菌培养。结果 VAS评分:放疗组为鼻塞4.0±0.8,流脓涕6.5±1.2,头痛4.3±0.6,嗅觉减退5.1±1.4,咳嗽2.7±1.2,打喷嚏3.7±0.8,面部疼痛和压迫感4.3±1.2,耳痛5.3±1.1;对照组为鼻塞4.3±0.7,流脓涕5.3±1.0,头痛3.3±0.8,嗅觉减退4.0±0.9,咳嗽3.3±1.0,打喷嚏3.7±0.9,面部疼痛和压迫感2.2±0.5;其中流脓涕、耳痛症状放疗组较对照组明显;鼻窦CT Lund-Mackay评分:放疗组为8.2±1.1,对照组为6.5±1.3;鼻内镜Lund-Kenndy评分:放疗组为6.2±1.1,对照组为4.7±0.7;上颌窦分泌物细菌培养结果:放疗组以金黄色葡萄球菌(6/15)、流感嗜血杆菌(3/15)为主,还有部分未查到细菌生长(4/15);对照组以金黄色葡萄球菌(24/36)、流感嗜血杆菌(6/36)、草绿色链球菌(5/36)为主。结论放疗致鼻窦炎较单纯慢性鼻窦炎有其自身特点,其发生机制可能与放射损伤鼻窦纤毛功能,窦口肿胀、阻塞,继发细菌感染有关。
Objective To analyze the clinical features of nasopharyngeal carcinoma secondary to chronic sinusitis after radiotherapy. Methods Visual analog scale (VAS) was performed in 40 patients with chronic sinusitis (radiotherapy group) and patients with chronic sinusitis (control group) from January 2011 to May 2013 in our department for outpatient and inpatient treatment. Evaluation of subjective nasal symptoms, endoscopic examination, sinus CT examination, and give the appropriate score. Radiotherapy group, 15 cases and 36 cases of control group received endoscopic sinus surgery, the line of maxillary sinus puncture, purulent discharge of bacteria culture. Results The VAS score was 4.0 ± 0.8 for nasal obstruction, 6.5 ± 1.2 for purulent tears, 4.3 ± 0.6 for headache, 5.1 ± 1.4 for hyposmia, 2.7 ± 1.2 for cough, 3.7 ± 0.8 for sneezing, 4.3 ± 1.2 for facial pain and pressure, Earache 5.3 ± 1.1; control group, nasal obstruction 4.3 ± 0.7, purulent tears 5.3 ± 1.0, headache 3.3 ± 0.8, olfactory dysfunction 4.0 ± 0.9, cough 3.3 ± 1.0, sneezing 3.7 ± 0.9, facial pain and pressure 2.2 ± 0.5; Luogan, otolarygia radiotherapy group was significantly more than the control group; sinus CT Lund-Mackay score: radiotherapy group was 8.2 ± 1.1, the control group was 6.5 ± 1.3; endoscopic Lund-Kenndy score: radiotherapy group was 6.2 ± 1.1 in the control group and 4.7 ± 0.7 in the control group. Bacterial culture results of maxillary sinus secretion: Staphylococcus aureus (6/15) and Haemophilus influenzae (3/15) were the main radiotherapy group, and some bacteria were not detected (4/15). The control group consisted of Staphylococcus aureus (24/36), Haemophilus influenzae (6/36) and Streptococcus viridans (5/36). Conclusions Radiotherapy causes sinusitis which has its own characteristics compared with chronic sinusitis. The mechanism may be related to the ciliary function, ostium swelling, obstruction and secondary bacterial infection.