本文選題：鼻咽癌　切入點：放射療法　出處：《南華大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 本課題擬對120例鼻咽癌（NPC）的患者在放療過程中及放療后分時段服用龍膽瀉肝丸或安慰劑，并在放療不同時間點進行主觀癥狀評價、電耳鏡、純音聽閾測試、聲導(dǎo)抗動態(tài)檢測及咽鼓管功能檢查，將放療前、放療劑量分別達20Gy、30Gy、50Gy時、以及放療結(jié)束時、結(jié)束后3個月、結(jié)束后6個月共7個不同時間點的各組相關(guān)數(shù)據(jù)進行統(tǒng)計分析，可以對放射性分泌性中耳炎（RSOM）在整個觀察期內(nèi)的發(fā)病率及NPC患者的中耳積分值進行動態(tài)觀察，探討RSOM發(fā)生規(guī)律及中耳積分值的變化規(guī)律，并總結(jié)出龍膽瀉肝丸對RSOM及中耳積分值的干預(yù)療效；并將在放療開始到放療結(jié)束后6個月確診的RSOM患者納入治療階段，于放療結(jié)束后6個月時將龍膽瀉肝丸對RSOM的臨床控制療效進行統(tǒng)計分析，并總結(jié)出龍膽瀉肝丸對RSOM的治療效果。 方法 隨機抽取符合標準的120例NPC放療患者，進行分組對照實驗。 實驗組包括90名接受放療患者： 第一組30名，從放療開始時服用安慰劑干預(yù)防治，劑量達20Gy到放療結(jié)束后6個月均服用龍膽瀉肝丸干預(yù)防治。 第二組30名，從放療開始時服用安慰劑干預(yù)防治，劑量達30Gy到放療結(jié)束后6個月均服用龍膽瀉肝丸干預(yù)防治。 第三組30名，從放療開始時服用安慰劑干預(yù)防治，劑量達50Gy到放療結(jié)束后6個月均服用龍膽瀉肝丸干預(yù)防治。 對照組包括接受放療的30名患者，從放療開始到放療結(jié)束后6個月均服用安慰劑干預(yù)防治。 結(jié)果 1、NPC患者在整個觀察期內(nèi)，出現(xiàn)RSOM的最早時間點為放療劑量達30Gy時，而最明顯的時間點為放療結(jié)束后3個月和6個月時，RSOM的發(fā)生不隨著放療的結(jié)束而終止。 2、隨著放療時間的推移，NPC患者在整個觀察期內(nèi)中耳積分值呈逐漸下降趨勢。本課題在（放療開始時到放療劑量達20Gy）及（放療劑量達30Gy到放療結(jié)束后3個月）這兩個時間點中耳積分值下降趨勢最明顯，實驗組在放療結(jié)束后3個月中耳積分值呈現(xiàn)緩慢上升趨勢，而對照組在整個觀察期內(nèi)積分值均呈現(xiàn)進行性下降。 3、經(jīng)計數(shù)資料X2檢驗，實驗組與對照組在干預(yù)與防治RSOM療效方面比較存在顯著性差異(p0.05)；經(jīng)Mann-Whitney U非參數(shù)秩和檢驗，實驗組與對照組在干預(yù)NPC患者中耳積分值方面存在顯著性差異(Sig0.05)。 結(jié)論 1、各組出現(xiàn)RSOM的最早時間點為放療劑量達30Gy時，放療結(jié)束后3個月和放療結(jié)束后6個月是RSOM的高發(fā)期，并且RSOM的發(fā)生并不隨著放療的結(jié)束而終止。如能盡早進行干預(yù)，可降低RSOM的發(fā)病率，改善NPC患者的中耳功能，提高其生活質(zhì)量。 2、龍膽瀉肝丸能明顯降低NPC患者在整個觀察期內(nèi)RSOM的發(fā)病率，，并對RSOM的臨床控制率明顯優(yōu)于對照組。 3、NPC患者中耳積分值在放療開始到放療劑量達20Gy及放療劑量達30Gy到放療結(jié)束后3個月這兩個階段下降趨勢最明顯。龍膽瀉肝丸能明顯干預(yù)NPC患者在整個觀察期內(nèi)中耳積分值變化，改善其中耳功能。
[Abstract]:Purpose. In this study, 120 patients with nasopharyngeal carcinoma (NPC) were treated with Gentian Xiegan pill or placebo during and after radiotherapy, and subjective symptom evaluation, audioscope, pure tone audiometry test were performed at different time points after radiotherapy. Dynamic detection of acoustic conductance and eustachian tube function test were conducted. The relevant data of 7 different time points were statistically analyzed before radiotherapy, when the radiation dose reached 20 Gy / 30 Gy / L 50Gy, 3 months after radiotherapy, 3 months after radiotherapy and 6 months after radiotherapy, respectively. The incidence of radioactive secretory otitis media (RSOM) during the whole observation period and the middle ear integral value of NPC patients can be observed dynamically, and the regularity of RSOM occurrence and the change of middle ear integral value can be discussed. The intervention effect of Longdan Xiegan pills on RSOM and middle ear integral value was summarized, and the RSOM patients diagnosed from the beginning of radiotherapy to the end of radiotherapy 6 months after radiotherapy were included in the treatment stage. The clinical control effect of Longdan Xiegan Pill on RSOM was statistically analyzed 6 months after radiotherapy, and the therapeutic effect of Longdan Xiegan Pill on RSOM was summarized. Method. One hundred and twenty patients with NPC were randomly selected and divided into two groups. The experimental group included 90 patients receiving radiotherapy:. The first group of 30 patients were treated with placebo from the beginning of radiotherapy. The dose of 20 Gy was 20 Gy and the treatment was treated with Longdan Xiegan pill 6 months after radiotherapy. In the second group, 30 patients were treated with placebo from the beginning of radiotherapy. The dose of 30 Gy was 30 Gy and the treatment was treated with Longdan Xiegan pill 6 months after radiotherapy. 30 patients in the third group were treated with placebo from the beginning of radiotherapy. The control group consisted of 30 patients who received radiotherapy and were treated with placebo from the beginning of radiotherapy to 6 months after radiotherapy. Results. 1 during the whole observation period, the earliest time point for the occurrence of RSOM was when the radiation dose was 30 Gy, and the most obvious time point was 3 months and 6 months after radiotherapy, and the occurrence of RSOM did not end with the end of radiotherapy. 2, with the time of radiotherapy, the integral value of middle ear in NPC patients showed a decreasing trend during the whole observation period. In this study, the two items were: (from the beginning of radiotherapy to the dose of 20 Gy) and from 30 Gy to 3 months after radiotherapy. The decreasing trend of the middle ear integral value is the most obvious at the time point, In the experimental group, the middle ear integral showed a slow upward trend 3 months after radiotherapy, while the control group showed a progressive decline in the whole observation period. 3After X2 test, there was a significant difference between the experimental group and the control group in the effect of intervention and prevention of RSOM, and by Mann-Whitney U non-parametric rank sum test, there was a significant difference between the experimental group and the control group in the intervention of middle ear integral value of NPC patients. Conclusion. 1. The earliest time point for the occurrence of RSOM in each group was when the radiation dose was 30 Gy, 3 months after the end of radiotherapy and 6 months after the end of radiotherapy, and the incidence of RSOM did not end with the end of radiotherapy. It can reduce the incidence of RSOM, improve the middle ear function of NPC patients and improve their quality of life. 2. Longdan Xiegan pills could significantly reduce the incidence of RSOM in patients with NPC during the whole observation period, and the clinical control rate of RSOM was significantly better than that of the control group. 3The decrease trend of middle ear integral value in patients with NPC was most obvious between the beginning of radiotherapy and radiotherapy dose of 20 Gy and radiotherapy dose of 30 Gy to 3 months after radiotherapy. Longdan Xiegan pill could significantly interfere with the change of middle ear integral value in patients with NPC during the whole observation period. Improve the function of the middle ear.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R818;R739.63

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