内耳受照剂量对头颈部肿瘤患者放射性感音神经性听力损伤影响的临床研究

发布时间：2018-05-23 14:40

本文选题：感音神经性听力损伤 + 内耳　；参考：《蚌埠医学院》2017年硕士论文

【摘要】：目的:本研究主要分析鼻咽癌患者内耳所受照剂量对感音神经性听力损伤的影响。资料与方法:收集2015年1月-2015年6月期间在蚌埠医学院第一附属医院肿瘤放疗科行同步放化疗的鼻咽癌患者53例,所有患者均经病理确诊为癌。所有患者由同一名放疗医师在定位图像上勾画出内耳,并利用剂量体积直方图(Dose-volume histograms),计算出每只耳的最大剂量(D max)、最小剂量(D min)及平均剂量(D mean)。所有患者在放疗开始前、放疗后6个月及放疗后12个月进行听力学测试,评价听力情况。入组患者年龄低于70周岁,放疗前鼓室图为A型。选择符合要求的患者,按照内耳所受照射剂量不同,分为低剂量组(内耳剂量低于45Gy)和高剂量组(内耳剂量高于45Gy)。比较内耳所受照射剂量与放疗后感音神经性听力损伤的发生率,同时了解放疗后时间、频率等因素对放疗后感音神经性听力损伤的影响。结果:低剂量组入组12人,高剂量组入组18人。低剂量组内耳所受照射剂量(Dmin、Dmean、Dmax)明显低于高剂量组,剂量差异有统计学意义(P0.01)。两组放疗后的第六个月和第12个月的自然语频(0.5Khz、1Khz、2Khz、4Khz)骨导阈值均较放疗前升高。放疗后低剂量组平均语频骨导阈值升高低于高剂量组,差异有统计学意义(P0.05)。低剂量组放疗后的第12个月严重听力损伤的发生率低于高剂量组,差异有统计学意义(P0.05)。低剂量组畸变产物耳声发射(DPOAE)检查通过率于放疗后的第12个月优于高剂量组,差异有统计学意义(P0.05)。结论:在同步放化疗的鼻咽癌患者中,当内耳所受照射剂量低于45Gy时,能够降低耳蜗毛细胞损伤情况,减轻听力损伤程度,降低严重听力损伤的发生率。
[Abstract]:Objective: to investigate the effects of radiation dose on sensorineural hearing loss in patients with nasopharyngeal carcinoma (NPC). Materials and methods: from January 2015 to June 2015, 53 patients with nasopharyngeal carcinoma (NPC) who received concurrent radiotherapy and chemotherapy in the tumor radiotherapy Department of the first affiliated Hospital of Bengbu Medical College were collected. All the patients were pathologically diagnosed as cancer. The inner ear was drawn by the same radiologist, and the maximum dose of Dose-volume histogramscan be calculated by the dosimetric volume histogram and the mean dose of D was calculated by the maximum dose of D maxus, the minimum dose of D min) and the average dose of D mean. Audiology tests were performed before, 6 months and 12 months after radiotherapy to evaluate the hearing status of all patients. The patients were under 70 years old and tympanogram was type A before radiotherapy. Patients who met the requirements were divided into low dose group (inner ear dose less than 45 Gy) and high dose group (inner ear dose higher than 45 Gy) according to the dose of inner ear. To compare the incidence of sensorineural hearing impairment between the dose of internal ear irradiation and the incidence of sensorineural hearing impairment after radiotherapy, and to understand the effects of time and frequency after radiotherapy on sensorineural hearing loss after radiotherapy. Results: 12 patients in low dose group and 18 in high dose group. The dose of Dmina Dmean Dmaxwas significantly lower in the low dose group than in the high dose group, and the dose difference was statistically significant (P 0.01). In both groups, the bone conductance threshold at the 6th month and 12th month after radiotherapy was higher than that before radiotherapy. The mean oral bone conductance threshold in low dose group was significantly higher than that in high dose group (P 0.05). The incidence of severe hearing loss in the low dose group was lower than that in the high dose group at the 12th month after radiotherapy, and the difference was statistically significant (P 0.05). The pass rate of distortion product otoacoustic emission (DPOAE) in the low dose group was higher than that in the high dose group at the 12th month after radiotherapy, and the difference was statistically significant (P 0.05). Conclusion: in patients with nasopharyngeal carcinoma treated with simultaneous radiotherapy and chemotherapy, when the dose of irradiation to the inner ear is lower than that of 45Gy, the damage of cochlear hair cells can be reduced, the degree of hearing damage can be alleviated, and the incidence of severe hearing impairment can be reduced.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.91;R730.55

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