鼻竇穿刺術用於治療鼻咽癌放療後併發鼻及鼻竇炎之初步研究

Preliminary Study of Antral Puncture for Rhinosinusitis in Patient with Nasopharyneal Carcinoma Post Radiotherapy

曹傑漢(Chien-Han Tsao)

指導教授 ： 周明智

中山醫學大學/醫學院/醫學研究所/碩士(2005年)

https://doi.org/10.6834/CSMU.2005.00096

摘要

鼻及鼻竇炎是鼻咽癌放療後患者最常見的併發症。導因於纖毛功能因放射線治療受損而無法排除鼻竇內分泌物，此情形與一般因發炎，過敏或感染所造成的黏膜腫脹或開口堵塞而形成的鼻竇炎不同。雖然是屬於較積極的治療方式，但是鼻竇穿刺術有下列優點；諸如快速清除蓄膿，改善缺氧環境以及正確採集檢體。將之施用於鼻咽癌放療後合併鼻及鼻竇炎患者，評估其在鼻塞，鼻異味，鼻涕倒流三項症狀的改善效果是否會比單評經驗給予藥物更能有效改善症狀，是本研究的主題。
採用回溯性研究方法，自2002年9月至2005年7月中山醫學大學附設醫院耳鼻喉部蒐集46名鼻咽癌放療後併發鼻及鼻竇炎且有鼻塞，鼻異味，鼻涕倒流症狀之門診病患；對鼻及鼻竇炎的診斷來自鼻塞，鼻異味及鼻涕倒流的病史。並經鼻竇X光片顯示上頷竇有瀰漫混濁，液氣相面，或黏膜增厚之病變來證實。依據病歷紀錄將治療前症狀嚴重者歸為3分，輕微但有症狀者歸為2分，無症狀者歸為1分。患者分為接受穿刺及接受經驗療法兩組，比較實施穿刺術與經驗療法的患者於治療7天後鼻塞，鼻異味，鼻涕倒流改善情形。
在46名鼻咽癌放療後合併鼻及鼻竇炎患者中，18名為實施穿刺術，28名為接受經驗療法。鼻塞，口鼻異味，鼻涕倒流3項症狀嚴重者，接受穿刺組其症狀改善程度較接受經驗療法組佳(p<0.05)。症狀輕微者，僅口鼻異味症狀較接受經
驗療法組佳(p<0.05)。
鼻竇穿刺術有清除蓄膿，改善缺氧環境及正確採樣的優點。我們的結果認為鼻竇穿刺術用於治療鼻咽癌放療後併發鼻及鼻竇炎，其症狀改善程度比僅憑經驗投與藥物好。

關鍵字

鼻咽癌 ； 鼻竇穿刺術 ； 鼻及鼻竇炎

並列摘要

Rhinosinusitis is a common complication in NPC patients who received radiotherapy. The defective elimination of secretion from paranasal sinuses may result from an impaired mucociliary function due to irradiation damage, a condition different to the pathogenesis of most rhinosinusitis, where the sinus ostia are blocked by a swollen mucosa because of irritation, allergy, or infection. Although somewhat aggressive, antral puncture has many advantages, including effective elimination of accumulated pus, immediate aeration of the maxillary sinus, and accurate sampling of the pathogens. The objective of this study is to compare the effectiveness of antral puncture in treating irradiated NPC patients with rhinosinusitis and that of using empirical antibiotics alone.
A retrospective study was performed on 46 irradiated NPC patients presented to the otolaryngological department of Chung Shan Medical University Hospital from September 2002 to July 2005. The diagnosis of rhinosinusitis was based on a history of blocked nose, foul smell and post-nasal drip, and was confirmed by radiographic abnormality, including clouding, air-fluid level, or mucosal thickening in the maxillary sinuses. The abovementioned symptoms were scored as 3, 2, 1 according to the severity, with 3 for serious ones, 2 for mild ones, and 1 for no symptom. The patients were divided into 2 groups; one included those who received antral puncture and the other who received empirical antibiotics alone. The severity of the sinonasal symptoms was compared in both groups before and 7 days after treatments.
Of the 46 irradiated NPC patients, 18 received antral puncture and 28 received empirical antibiotics alone. The patients with antral puncture had a significantly higher frequency of the improvement of the serious symptoms (stuffy nose, foul smell, and post nasal drip) than those with empirical antibiotics alone (p<0.05).There were no difference in the improvement of the mild symptoms between the two groups, except that the antral puncture group had a significantly higher percentage of the improvement of foul smell compared with the empirical antibiotics group (p<0.05).
The advantages of antral puncture include effective clearing of accumulated pus, immediate improvement of asphyxia, and correct sampling of the pathogens. Our data showed a significant improvement of sinonasal symptoms in irradiated NPC patients who received antral puncture than those received antibiotic therapy only.

並列關鍵字

nasopharyngeal carcinoma ； antral puncture ； rhinosinusitis

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