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近年来,甲状腺癌的发病率逐渐增高,是全球女性癌症发病率前5的疾病之一[1]。甲状腺癌的病理类型以DTC最为常见,包括乳头状和滤泡状2种分型。使用131I消融甲状腺切除术后残留的甲状腺组织及转移灶是国内外公认的DTC治疗方案[2-3]。但是,行大剂量131I放疗的同时,131I也可被唾液腺摄取并浓缩,由此造成的唾液腺功能损伤问题也逐渐受到临床关注[4]。放疗引起的唾液分泌不足、口干症、黏膜炎、口腔营养缺乏、口腔感染和其他功能改变(例如咀嚼困难、吞咽困难及味觉丧失等)均会显著降低患者的生活质量[5]。笔者现结合国内外文献报道,对131I治疗后DTC患者唾液腺损伤的机制、症状、诊断及防治措施予以综述。
分化型甲状腺癌患者131I治疗后唾液腺功能变化的诊疗进展
Progress in diagnosis and treatment of salivary gland function changes in patients with differentiated thyroid cancer after 131I treatment
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摘要: 唾液腺功能受损是头颈部肿瘤患者放化疗中常见的不良反应,其对患者的生活质量及治疗效果产生严重影响,唾液腺功能受损发生率随着头颈部疾病发病率的增高而增高,亟需明确的防治手段。目前已有大量国内外研究结果揭示了唾液腺功能放射性损伤的部分机理并提供了一些防治措施予以临床参考。笔者重点综述由131I治疗引起的唾液腺功能损伤的机制、症状、诊断及防治措施。Abstract: The impairment of salivary gland function is a common adverse reaction in radiotherapy and chemotherapy of head and neck tumors, which has a serious impact on the quality of life and treatment effect of patients. The incidence of salivary gland dysfunction increases with the increase of the incidence of head and neck diseases. Clear prevention and treatment methods are urgently needed. At present, a large number of domestic and foreign studies have revealed the possible mechanism of the impaired salivary gland function caused by radiation therapy and provided some prevention and treatment measures for clinical reference. This review focuses on the mechanism, symptoms, diagnosis and prevention of salivary gland dysfunction caused by 131I therapy.
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