鼻咽癌中的颅底放射性骨坏死：血管化皮瓣的长期结局
Skull Base Osteoradionecrosis in Nasopharyngeal Carcinoma: Long-Term Outcomes of Vascularized Flaps.
文献信息
| PMID | 42988578 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Xinni Xu |
| 作者单位 | Department of Otolaryngology-Head & Neck Surgery, National University Hospital, Singapore, Singapore. |
| 期刊 | The Laryngoscope |
| SCI 分区 | Q2 |
| IF | 2.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
目的： 颅底放射性骨坏死（ORN）是既往接受放疗的鼻咽癌（NPC）患者的一种晚期但致残性并发症。患者常遭受慢性疼痛和反复出血，最终可导致颈动脉破裂。本研究考察颅底ORN在长期随访中的自然史，以及保守治疗和手术治疗的结局。
方法： 对2011年6月至2025年12月期间在一家三级中心接受治疗的伴有颅底ORN的放疗后NPC患者进行回顾性综述。结局指标为症状控制、颈动脉破裂发生率和生存率。
结果： 共28例患者，随访时间为23.0（14.0-31.0）年。ORN征象在放疗后14.0（6.0-23.0）年出现。最常见的症状是反复出血（85.7%）。颈动脉破裂发生率为53.6%。ORN诊断后的生存时间为5.0（2.0-8.0）年。18例患者（64.3%）接受保守治疗。10例患者（35.7%）接受内镜下清创和血管化皮瓣重建。与保守治疗者相比，接受手术者的症状控制更好、颈动脉破裂发生率更低（20.0% vs. 72.2%，p = 0.008），总生存期更长（29.0 [10.0-31.0] vs. 21.5 [14.0-36.0]年，p < 0.001）。
结论： 颅底ORN诊断后的生存情况总体较差。保守治疗与较差的症状控制相关，并常最终进展为颈动脉破裂。早期识别ORN，并在适当选择的患者中及时进行手术清创联合血管化皮瓣重建，可能提供更好的症状控制、减少进展为颈动脉破裂，并可能带来生存获益。
英文摘要
OBJECTIVES: Skull base osteoradionecrosis (ORN) is a late but debilitating complication of previously irradiated nasopharyngeal carcinoma (NPC). Patients often suffer from chronic pain and recurrent bleeding, which can culminate in a carotid blowout. This study examines the natural history of skull base ORN over a long follow-up, and the outcomes with conservative and surgical management.
METHODS: A retrospective review (June 2011 to December 2025) of radiated NPC patients with skull base ORN managed at a tertiary center was performed. Outcome measures were symptom control, incidence of carotid blowout and survival.
RESULTS: There were 28 patients with a follow-up of 23.0 (14.0-31.0) years. Signs of ORN developed at 14.0 (6.0-23.0) years after radiotherapy. The most common symptom was recurrent bleeding (85.7%). The incidence of carotid blowout was 53.6%. Survival after ORN diagnosis was 5.0 (2.0-8.0) years. Eighteen patients (64.3%) were managed conservatively. Ten patients (35.7%) underwent endoscopic debridement and vascularized flap reconstruction. Patients who underwent surgery had better symptom control, lower incidence of carotid blowout (20.0% vs. 72.2%, p = 0.008) and longer overall survival (29.0 [10.0-31.0] vs. 21.5 [14.0-36.0] years, p < 0.001) than those managed conservatively.
CONCLUSIONS: Survival after skull base ORN diagnosis was generally poor. Conservative management was associated with poorer symptom control and frequently progressed to carotid blowout eventually. Early recognition of ORN and timely surgical debridement with vascularized flap reconstruction in appropriately selected patients may provide better symptom control, reduce progression to carotid blowout, with a potential survival benefit.