【摘要】 目的探讨鼻咽癌(NPC)放疗对视觉通路损伤及相关因素。方法观察进行首程放疗的254例NPC患者在治疗前、中及后视功能改变,包括远视力、眼底、视野及视诱发电位(PVEP)检查;对发生放疗性视网膜病变或有脑损伤临床表现的患者予以CT或MRI检查。结果放疗性视网膜病变发生率9.4%(24/254),放射性脑损伤发生率6.3%(16/254);视网膜病变早期(Ⅰ～Ⅱ级)PVEP的P100潜伏期(PL)正常[(84.2～102.9)ms],晚期(Ⅲ～Ⅳ级)以及出现视神经、脑损伤时,P100PL均明显延长,分别为112.2～123.2ms、112.4～137.6ms和127.5～168.6ms。本组91.7%(22/24)放疗性视网膜病变和8例脑干损伤发生在治疗后3年内。38.1%(8/24)视网膜损伤后(15.6±8.3)个月发生颞叶损伤,颞叶损伤者均先有放疗性视网膜损伤。有2例在放疗后2和3个月时发生视野损害,于首程放疗结束后9和30个月发生脑干损伤。照射剂量75～79Gy组视网膜病变和脑损伤发生率都明显比70～74Gy组高(均P<0.05)。结论NPC放疗后颞叶损伤均发生在视网膜病变之后,观察放疗性视网膜病变对发现早期放射性颞叶脑损伤可能有一定意义;放射性视网膜病变和脑损伤与照射剂量相关;视野检测对放疗后视路损伤评估有一定意义。更多还原

【Abstract】 Objective To investigate the effect and related factors of radiotherapy on the visual pathway funtion in patients with nasopharyngeal carcinoma(NPC).Methods 254 NPC patients who initially received radiation were observed with visual acuity, automational visual field, slit-lamp microscopic findings, pattern visual evoked potential ( P-VEP ) and fundal findings at before, during and after radiotherapy.The CT or MRI were performed for patients with radiation retinopathy or clinical manifestations of brain injury.Results The radiation retinopathy rate was 9.4%(24/254) and radiation brain injury was 6.3%(16/254). The P100 peak latency (PL) of VEP in patients with early stage retinopathy (Ⅰ~Ⅱ level ) is normal in 84.2~102.9 ms, but the patients with late stage retinopathy (Ⅲ~Ⅳ level) and optic nerve and brain injury are abnormal in 112.2～123.2 ms,112.4～137.6 ms and 127.5～168.6 ms. The radiation retinopathy incidence of 91.7% (22/24) and 8 patients with brain stem injury had happened in first 3 years after radiotherapy in patients with NPC. 38.1%(8/24) of patients had injury in temporal lobe after radiation retinopathy (15.6±8.3) months.The patients with injury in temporal lobe are earlier than radiation retinopathy. The visual field injury in 2 patients were found during in 2 and 3 months after radiotherapy, and the brain stem injury had been observed after 9 and 30 months since first term of radiotherapy.The radiation retinopathy and encephalopathy rates of patients with radiation dose in 75~79 Gy are significantly higher than that of in 70～74 Gy (all P<0.05).Conclusions Radiation-induced injury of brain in temporal lobe is follow up radiation retinopathy. Following-up radiation retinopathy may be of real significance in early diagnosis of radiation injury of brain in temporal lobe. Radiation retinopathy and encephalopathy are significantly related to the radiation dose. The visual field detection may be helpful for evaluating to radiation visual pathway injury in eyes after radiotherapy.更多还原