| 摘要: |
| ［摘要］ 目的 回顾性分析鼻咽癌放疗后颅底组织坏死患者的临床资料，建立一种可指导手术治疗和预后风险评估的分级方案。方法 纳入南方医科大学珠江医院、广东省人民医院2017年1月至2020年1月资料齐全的鼻咽癌放疗后颅底组织坏死手术病例共100例，随访皆无肿瘤复发。根据影像病变部位、操作难度、临床手术风险，并结合长期的临床经验，提出基于影像资料的分级方法。分析不同分级病变与手术效果、预后的关系。结果 根据拟定的分级标准，本研究纳入的100例患者中Ⅰ级17例，Ⅱ级30例，Ⅲ级22例，Ⅳ级26例，Ⅴ级5例。多因素logistic回归分析表明，放疗次数（OR=0.214，P=0.004）、CT分级（OR=19.371，P=0.022）是影响手术成功率的独立危险因素。根据设定的治愈条件，手术总成功率为71.00%，其中Ⅰ级88.24%，Ⅱ级86.67%，Ⅲ级68.18%，Ⅳ级53.85%（鼻内黏膜瓣47.62%，颞肌瓣80.00%），Ⅴ级20.00%（鼻内黏膜瓣0%，颞肌瓣100.00%）。中位随访时间为10.29个月。结论 对鼻咽癌放疗后颅底组织的CT影像学表现进行分级，能够有效地评估预后风险及指导手术治疗。 |
| 关键词: 鼻咽癌 颅底组织坏死 影像学分级 手术治疗 |
| DOI：10.3969/j.issn.1674-3806.2023.01.01 |
| 分类号:R 739.63 |
| 基金项目:国家自然科学基金项目（编号：82171104） |
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| CT imaging grading and discussion on surgical treatment of skull-base tissue necrosis after radiotherapy for nasopharyngeal carcinoma |
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QIU Qian-hui, CHEN Hai-ling, CUI Yi, et al.
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Department of Otolaryngology & Head and Neck Surgery, Guangdong Provincial People′s Hospital(Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
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| Abstract: |
| ［Abstract］ Objective To establish a grading scheme that can guide surgical treatment and prognostic risk assessment by retrospective analysis of the data of the patients with skull-base tissue necrosis after radiotherapy for nasopharyngeal carcinoma. Methods A total of 100 surgical cases of skull-base tissue necrosis after radiotherapy for nasopharyngeal carcinoma were enrolled into this study from Zhujiang Hospital, Southern Medical University and Guangdong Provincial People′s Hospital during January 2017 and January 2020. All the cases had been followed up with no recurrence. According to the imaging lesion sites, the difficulty of operative procedure, the risk of clinical surgery, combined with long-term clinical experience, a grading method based on the image data was proposed and the relationship between the different grades of lesions and the surgical effect and prognosis was analyzed. Results The 100 cases enrolled in this study were classified into grade Ⅰ in 17 cases, grade Ⅱ in 30 cases, grade Ⅲ in 22 cases, grade Ⅳ in 26 cases and grade Ⅴ in 5 cases according to the proposed grading standards. The results of multiple logistic regression analysis showed that radiotherapy frequency［odds ratio(OR)=0.214, P=0.004) and CT grade(OR=19.371, P=0.022) were independent risk factors affecting the success rate of the surgery. Based on the standard of cure that we set, the total success rate of the surgery in this study was 71.00%, of which 88.24% for grade Ⅰ, 86.67% for grade Ⅱ, 68.18% for grade Ⅲ, 53.85% for grade Ⅳ(intranasal mucosal flap 47.62% and temporalis fascia flaps 80.00%) and 20.00% for grade Ⅴ(intranasal mucosal flap 0% and temporalis fascia flaps 100%). The median follow-up time was 10.29 months. Conclusion A grading scheme is successfully established based on the imaging manifetations of skull-base tissue necrosis after radiotherapy for nasopharyngeal carcinoma, which can effectively assess the prognostic risk and guide the surgical treatment. |
| Key words: Nasopharyngeal carcinoma Skull-base tissue necrosis Imaging grading Surgical treatment |
