头颈部肿瘤行放射治疗后继发鼻窦炎的临床病例分析研究

发布时间：2018-01-13 10:07

本文关键词：头颈部肿瘤行放射治疗后继发鼻窦炎的临床病例分析研究　出处：《兰州大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：探索接受放射治疗(放疗)后继发鼻窦炎的头颈部恶性肿瘤患者的临床特点,并分析影响其发生的临床因素及相应的治疗方法。方法：连续纳入2009年至2011年在我院因头颈部恶性肿瘤行放疗(靶区均包括部分鼻窦)的患者,分析相关的临床病例资料,通过logistic回归模型鉴定能影响鼻窦炎发生的因素。此外,评价鼻腔冲洗疗法对继发鼻窦炎的疗效。统计学分析使用SPSS 17.0软件。结果：共纳入86例患者。放疗前16例(19%)患者有鼻窦炎病史,放疗后55例(64%)患者发生鼻窦炎。与未发生鼻窦炎组相比,继发鼻窦炎组的中晚期患者(肿瘤T分级2期)比例(96% vs.59%,P0.05)较高,发生鼻腔组织器官侵犯的比例也较高(42%vs.18%,P0.05),使用鼻腔冲洗治疗的比例较低(75%vs.94%,P0.05)。两组在年龄(50±10 vs.48±9)、性别(55% vs.50%)、淋巴结转移(84%vs.70%)、滴鼻剂使用(20%vs.17%)方面差异无统计学意义(P0.05)。单因素及多因素的logistic回归分析结果显示：患者的年龄(岁)、性别(男性,%)、已出现淋巴结转移、应用滴鼻剂治疗,并未影响患者鼻窦炎的发生(P0.05),而患者的肿瘤T期级别较严重、肿瘤已侵犯鼻腔,是影响放疗后发生鼻窦炎的因素[比值比(odds ratio,OR):1.86,95%可信区间(confidence inerval,CI):1.20-2.80,P0.05;OR=2.09,95%CI：1.10-3.98,P0.05],放疗中及放疗后给予鼻腔冲洗局部治疗的患者鼻窦炎发生风险较低(OR=0.22,95%CI：0.11-0.59,P0.05)。此外,对放疗前有鼻窦炎病史的患者,绝大部分患者放疗后没有得到改善,CT扫描结果显示仅有4例患者鼻窦炎好转,治疗前后比较差异无统计学意义(P0.05),部分患者甚至有所加重。18例患者因过多使用含有鼻血管收缩剂成分的药物(不间断应用至少1月),出现了药物性鼻炎。结论：头颈部恶性肿瘤患者放疗后鼻窦炎的发病率高,肿瘤的T分期较高、肿瘤侵犯鼻腔、使用鼻咽冲洗治疗是放疗后继发鼻窦炎的独立预测因素。在临床中,若患者的肿瘤T期分级较高、肿瘤已侵犯鼻腔,可使用为期6月的鼻咽冲洗治疗,以降低头颈部肿瘤患者放疗后继发鼻窦炎的发生率,并减轻鼻窦炎的症状,提高患者的生活质量。
[Abstract]:Objective: to explore the clinical features of head and neck malignant tumors secondary to sinusitis after radiotherapy. The clinical factors affecting its occurrence and the corresponding treatment methods were analyzed. Methods: from 2009 to 2011, patients with head and neck malignant tumors received radiotherapy (including part of the paranasal sinuses in the target area) in our hospital. To analyze the clinical data and identify the factors that influence the occurrence of sinusitis by logistic regression model. To evaluate the efficacy of nasal irrigation therapy in the treatment of secondary sinusitis. SPSS 17.0 software was used in statistical analysis. Results: 86 patients were included. 16 patients with sinusitis had a history of sinusitis before radiotherapy. After radiotherapy, 55 patients with sinusitis developed sinusitis. Compared with those without sinusitis, 96% of patients with secondary sinusitis (stage 2 of tumor T grade) had secondary sinusitis (96% vs.59%). P0.05) was higher, and the rate of nasal organ invasion was also higher (42vs.18). The proportion of nasal irrigation treatment was lower than 75vs.94%. P0.05. The age of the two groups was 50 卤10 vs.48 卤9, sex was 55% vs.50, lymph node metastasis was 84 vs 70). There was no significant difference in the use of nasal drops 20 vs.17 (P 0.05). Univariate and multivariate logistic regression analysis showed that the age of the patient was (age). Sex (male sepsis, lymph node metastasis, nasal drops treatment, did not affect the occurrence of sinusitis in patients with P0.05, and the patient's tumor T stage grade is more serious, tumor has invaded nasal cavity. It is a factor influencing sinusitis after radiotherapy. [Odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds / odds. P0.05; The risk of sinusitis in patients who were given nasal irrigation local treatment during radiotherapy and after radiotherapy was lower than OR0.22. 95 CI: 0.11-0.59, P0.05. in addition, most of the patients who had a history of sinusitis before radiotherapy did not get any improvement after radiotherapy. Ct scan showed that only 4 cases of sinusitis improved, the difference before and after treatment was not statistically significant (P0.05). Some patients were even aggravated. 18 patients were overused with drugs containing nasal vasoconstrictors (uninterrupted use of at least January). Conclusion: the incidence of sinusitis in patients with malignant tumor of head and neck after radiotherapy is high, the T stage of tumor is higher, and the tumor invades nasal cavity. The use of nasopharyngeal irrigation is an independent predictor of secondary sinusitis after radiotherapy. In clinic, if the tumor has a higher T grade and the tumor has invaded the nasal cavity, it can be treated with nasopharyngeal lavage for a period of June. In order to reduce the incidence of secondary sinusitis after radiotherapy in patients with head and neck tumors, and alleviate the symptoms of sinusitis, improve the quality of life of patients.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R739.91

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