鼻内窥镜下Nd∶YAG激光手术配合术后放疗治疗复发性和残余性鼻咽癌疗效观察

Exploring the possibility of Endoscopic Nd∶YAG Laser Treatment for Nasopharyngeal Cancer

目的 探讨激光手术加放疗治疗复发性和残余性鼻咽癌的可行性和临床疗效。方法 ６１ 例鼻咽癌患者，采用激光加放疗方法治疗者（激光加放疗组）３５ 例，其中２８ 例为复发性、７ 例为残余性鼻咽癌；单纯采用放疗者（ 单纯放疗组）２６ 例，其中复发性者２０ 例，残余性者６ 例。两组放疗术后复发时间及肿瘤ＴＮＭ 分期无显著性差异。激光加放疗组在鼻内窥镜下用Ｎｄ∶ＹＡＧ激光（功率５０ Ｗ） 汽化切除肿瘤病灶，术后２ 周行６０Ｃｏ 外照射，剂量为２０～３０ Ｇｙ。单纯放疗组分别选用颈面联合野、鼻前野、颈后切线野行６０Ｃｏ 外照射，剂量为４０～６０ Ｇｙ。以放疗结束后６ 个月鼻咽肿瘤消失情况进行疗效评价。结果 激光加放疗组肿瘤完全消失率为６５－７％ （２３／３５），部分消失率为２８－６ ％ （１０／３５）；单纯放疗组肿瘤完全消失率为１５－４％（４／２６），部分消失率３４－６ ％（９／２６） ，两组肿瘤完全消失率比较，差异有非常显著意义（χ２＝ １１－２，Ｐ＜０－０１）。结论 鼻内窥镜下Ｎｄ∶ＹＡＧ激光手术加放疗是治疗复发性和残余性鼻咽癌的有效手段。

Objective To explore the possibility and effect of endoscopic Nd∶YAG laser treatment for recurrent or residual nasopharyngeal carcinoma. Methods 61 patients with recurrent or residual nasopharyngeal carcinoma were differently treated. Radiotherapy was accepted after endoscopic Nd∶YAG laser operation in 35 cases (radiotherapy plus laser operation), among them 28 cases with recurrent and 7 cases residual carcinoma. Radiotherapy alone was adopted in 26 cases, among them 20 cases with recurrent and 6 cases residual carcinoma. A dose of 20-30 Gy was adopted in radiotherapy plus laser operation group in which 60 Co external irradiation was performed 2 weeks after operation, and a dose of 40-60 Gy was used in the radiotherapy alone group. The degree of nasopharyngeal carcinoma subsidence was evaluated 6 months after radiotherapy. Results The tumor was eradicated completely in 65 7%(23/35) and partially in 28 6%(10/35) of patients in the laser plus radiotherapy group. The carcinoma disappeared completely in 15 4%(4/26) and partially in 34 6%(9/26) in the radiotherapy alone group. Results of tumor eradication in laser plus radiotherapy group showed very significant difference as compared with that of radiotherapy alone group (χ 2=11 2,P<0 01). Conclusions Endoscopic Nd∶YAG laser therapy is a new effective method for the treatment of reccurent and residual nasopharyngeal cancer.