Nasolacrimal duct obstruction following radioactive iodine 131 therapy in differentiated thyroid cancers: review of 19 cases
Nasolacrimal duct obstruction following radioactive iodine 131 therapy in differentiated thyroid cancers: review of 19 cases
复制标题
放射性碘131治疗分化型甲状腺癌后鼻泪管阻塞：19例回顾
作者：
K. Al;M. Al Asiri;M. Tunio;N. Aljohani;Y. Bayoumi;I. Munir;Ayman Alayoubi
背景 放射性碘 131 (131I) 疗法长期以来一直用于治疗分化型甲状腺癌 (DTC)。虽然继发于 131I 治疗的唾液腺和泪腺并发症已有充分记录，但文献中很少涉及鼻泪管阻塞 (NLDO)。我们的目的是评估 131I 治疗获得性 NLDO 的频率、其与 131I 治疗剂量的相关性，以及这种罕见副作用的手术治疗结果。方法 对 2000 年至 2012 年 1,192 例确诊 DTC 患者中的 864 例接受 131I 治疗的患者进行回顾性分析，检查 NLDO 的发生率、其致病因素以及影像学、手术干预和结果。结果 19 名 (2.2%) 患者被确定患有 NLDO。平均年龄为 51.9±10.5 岁（范围：39-72 岁）。 15 名（78.9%）为女性，4 名为男性（21.1%）。平均个体 131I 剂量为 311.1±169.3 毫居里 (mCi)（范围：150–600 mCi）。 131I 治疗日期与 NLDO 发生之间的平均持续时间为 11.6±4.1 个月（范围：6.5-20）。 14 例（73.7%）患者出现双侧溢泪。计算机断层扫描泪液成像技术可以检测所有 NLDO。 18 名（94.7%）患者接受了泪囊鼻腔吻合术。 14 名患者（73.7%）完全康复。年龄>45岁和131I治疗剂量>150 mCi与NLDO显着相关（分别P=0.02和P=0.03）。结论 NLDO 是 DTC 患者 131I 治疗的一个被低估的并发症。临床医生应该意识到这种罕见的并发症，以便及时干预。
Background Radioactive iodine 131 (131I) therapy has long been used in the treatment of differentiated thyroid cancers (DTC). While salivary and lacrimal glandular complications secondary to 131I therapy are well documented, there is little in the literature addressing nasolacrimal duct obstruction (NLDO). We aimed to evaluate the frequency of 131I therapy-acquired NLDO, its correlation to 131I therapy doses, and the surgical treatment outcome of this rare side effect. Methods From 2000–2012, a retrospective review of 864 among 1,192 patients with confirmed DTC who were treated with 131I therapy was performed to examine the frequency of NLDO, its causative factors, as well as imaging, surgical intervention, and outcomes. Results Nineteen (2.2%) patients were identified with NLDO. The mean age was 51.9±10.5 years (range: 39–72 years). Fifteen (78.9%) were female and four were male (21.1%). The mean individual 131I doses were 311.1±169.3 millicurie (mCi) (range: 150–600 mCi). The mean duration between the date of 131I therapy and the occurrence of NLDO was 11.6±4.1 months (range: 6.5–20). Fourteen (73.7%) patients had bilateral epiphora. Computed tomography dacryography allowed for the detection of all NLDO. Eighteen (94.7%) patients underwent dacryocystorhinostomy. Complete recovery was obtained in 14 (73.7%) patients. Age >45 years and 131I therapy doses >150 mCi were significantly correlated with NLDO (P=0.02 and P=0.03, respectively). Conclusion NLDO is an underestimated complication of 131I therapy in DTC patients. Clinicians should be aware of this rare complication for prompt intervention.