鼻咽癌局部复发或残留病灶的Nd：YAG激光手术挽救治疗

目的 探讨Nd:YAG激光手术挽救治疗鼻咽癌放射治疗后鼻咽局部复发或残留的可行性和临床疗效。方法在鼻内镜下经鼻腔Nd:YAG激光,对35例鼻咽癌经根治性放射治疗后鼻咽局部复发或残留病灶进行治疗。手术在局麻下进行,在鼻内镜直视下,激光功率调整在50W左右,YAG激光光纤经同侧或对侧鼻腔导入鼻咽部,气化切除肿瘤病灶。部分患者术后接受了再放射治疗,放射剂量20-60Gy不等。结果 手术均顺利完成。术后3年、5年生存率分别为51.4%、30.3%。结论 鼻内镜下Nd:YAG激光挽救手术是治疗鼻咽癌放射治疗后鼻咽局部复发或残留的有效手段,丰富了鼻咽癌放射治疗失败后的外科治疗手段。术后是否再需放射治疗,视具体情况决定。

YAG laser salvage surgery of recurrent or residual nasopharyngeal carcinoma after radiotherapy

JECTIVE To investigate the possi-bility and effect of Nd: YAG laser salvage surgery for recurrent or residual nasopharyngeal carcinoma after radiotherapy. METHODS Thirty-five cases of recurrent or residual nasopharyngeal carcinoma were treated by Nd: YAG laser salvage surgery under nasal endoscope from January 1995 toi December 1998. All patients received radiotherapy before surgery with the dose of 65Gy-140Gy. The patients were recurrent or residual carcinoma at the nasopharynx and no distant metastasis. The operation was under local anesthesia, the Nd: YAG laser power was about 50W. RESULTS The Nd: YAG laser salvage surgery for nasopharyngeal carcinoma after full-dose-radiation failure was finished satisfactorily, the three- and five-year survival rate were 51.4 %(18/35)and 30.3 %(10/33) respectively. CONCLUSION Nd: YAG laser salvage surgery is a new effective method for the treatment of recurrent or residual nasopharyngeal carcinoma after radiotherapy failure at the nasopharynx.