鼻竇穿刺術用於治療鼻咽癌放療後鼻及鼻竇炎之初步研究

Preliminary Study of Antral Puncture for Rhinosinusitis in Irradiated Patients with Nasopharyngeal Carcinoma

曹傑漢(Chien-Han Tsao) ； 蘇茂昌(Mao-Chang Su) ； 辛宗翰(Chung-Han Hsin) ； 莊俊義(Chun-Yi Chung) ； 陳宣志(Shiuan-Chih Chen) ； 廖孟琴(Meng-Chin Liao) ； 周明智(Ming-Chih Chou)

《台灣耳鼻喉頭頸外科雜誌》 41卷1期 (2006/02) Pp. 7-18

https://doi.org/10.6286/2006.41.1.7

摘要

BACKGROUND: 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.
METHOD: 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.
RESULT: 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).

關鍵字

鼻咽癌 ； 鼻竇穿刺術 ； 鼻及鼻竇炎

並列摘要

BACKGROUND: 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.
METHOD: 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.
RESULT: 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).

並列關鍵字

nasopharyngeal carcinoma ； antral puncture ； rhinosinusitis