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[目的]探讨局部晚期鼻咽癌调强放疗与颈动脉损伤的关系。[方法]系统随访91例Ⅲ~Ⅳa期鼻咽癌初治患者。全组患者均采用调强放疗技术(原发灶总剂量70~72Gy/32f,42~44d;颈淋巴结转移灶65~68Gy/32f,42~44d;高危预防区域60Gy/32f,42~44d;低危预防区域50Gy/28f,35~38d)放疗结束后定期通过磁共振颈血管成像(MRA)和/或颈部血管彩色多普勒随访患者颈动脉损伤发生情况。[结果]至随访截止日,91例患者中共有20例在MRA和/或颈部血管彩色多普勒上表现出颈动脉损伤,发生率为22.0%,1年、2年、3年、4年的发生率分别为11.0%(10/91)、16.5%(15/91)、20.9%(19/91)、22.0%(20/91),其中有10例患者同时进行了MRA及颈部血管彩色多普勒检查,6例患者颈部血管彩色多普勒的阳性结果出现在MRA之前,3例患者仅颈部血管彩色多普勒有阳性结果,1例两者同时发现颈部血管损伤。发生损伤的主要部位为颈总动脉(12例)、椎动脉(11例)及颈内动脉(6例)。[结论]局部晚期鼻咽癌患者调强放疗后颈动脉损伤的发生率高,联合多种影像学检查定期复查可以及早发现放疗后颈动脉损伤。
[Objective] To investigate the relationship between intensity modulated radiation therapy and carotid artery injury in locally advanced nasopharyngeal carcinoma. [Methods] A total of 91 patients with stage Ⅲ-Ⅳa nasopharyngeal carcinoma were followed up systematically. All patients were treated with IMRT (total dose of primary tumor was 70-72Gy / 32F for 42-44d; cervical lymph node metastasis was 65-68Gy / 32f for 42-44d; high-risk prevention area was 60Gy / 32F for 42-44d; Low-risk prevention area 50Gy / 28f, 35 ~ 38d) after the end of radiotherapy by magnetic resonance imaging of the neck (MRA) and / or neck vascular color Doppler follow-up of patients with carotid artery injury. [Results] Twenty cases of 91 patients had carotid artery injury on color Doppler MRA and / or neck vessels at the follow-up deadline (22.0%, 1 year, 2 years, 3 years, 4 years The annual incidence rates were 11.0% (10/91), 16.5% (15/91), 20.9% (19/91) and 22.0% (20/91) respectively. Ten of them had MRA and neck Vascular color Doppler examination, 6 cases of cervical vascular color Doppler positive results in front of MRA, 3 cases of patients with only cervical blood vessels by color Doppler positive results, both in 1 case both found in the neck vascular injury . The main sites of injury were the common carotid artery (12 cases), the vertebral artery (11 cases) and the internal carotid artery (6 cases). [Conclusion] The incidence of carotid artery injury in locally advanced nasopharyngeal carcinoma patients after IMRI is high. Combined with multiple imaging examinations, the carotid artery injury can be detected early after radiotherapy.