鼻腔鼻窦晚期恶性肿瘤的激光治疗

我院从１９７９～１９９１年用激光和光动力学治疗４９例晚期和复发性鼻腔鼻窦恶性肿瘤。采用的方法：（１）经颅面径路用激光切除部分前颅窝底２例。其法为先经颅面径路充分暴露肿瘤侵犯的前颅窝底，继用Ｎｄ：ＹＡＧ激光照射距肿瘤周围１ｃｍ的正常颅底骨质，使其脱水变白，再用ＣＯ２激光切割，去除病变颅底。术中应用盐水纱布保护，以防损伤脑膜和正常组织。已分别随访３年和１年无复发。（２）激光和光动力学治疗复发性鼻窦癌４７例。其法为若复发性癌瘤面积较小、局限浅表，则先用Ｎｄ：ＹＡＧ激光凝固周边正常组织和癌瘤，继用ＣＯ２激光汽化；若肿瘤面积较大，浸润较深，周边境界不清，则用激光和光动力学联合治疗。即先用激光汽化可见的肿瘤，残留部分再用光动力学治疗；若肿瘤深在，激光难以汽化或照射，可再经鼻侧上唇切开，充分暴露肿瘤后按上法治疗；对颈部有淋巴结转移者，除用上法治疗复发性癌瘤外，可行功能世或根治性颈淋巴结切除术。随访５年未复发１４例（２９．８％），３年未复发１０例（２１．３％），１年未复发１２例（２５．５％），无效１１例（２３．４％）。

Laser Treatment of Malignant Tumors of the Nasal Cavity and Paranasal Sinuses

Forty-nine cases of advanced and recurrent malignant tumors in the nasal cavity and paranasal sinuses were treated by CO2,Nd:YAG lasers and photodynamic therapy(PDT)in this department from 1979 to 1991.Two patients with cancer involving the skull base in the front cranial fossa were treated by ND:YAG and CO2,lasers through the craniofacial section,The procedure was as following:The diseased cranial base was sufficiently exposed through the section.The tumor and the surrounding normal bone of 1cm in width were illuminated bv Nd:YAG laser untill it did not become pale.Finally it was followed by its cutting off with CO2 laser.Attention was paid to protect the meninx and surrounding normal tissues from photo-damage by covering with moist gauze,No recurrence was detected in those 2 cases, followed up for 1 and 3 years,re-spectively.47 cases with recurrent cancers in the paranasal sinuses were treated by laser and PDT,Small,localized and superficiaI tumors were coagulated by Nd:YAG laser and then vaporized by CO2 laser.In the cases oflarge and deeply infiltrating tumors,after vaporization of the visible tumors,the tumor bed was followed byPDT to eradicate the residual tumor tissue.In the cases that the tumor was deeply located and difficult to ac-cess,to be irradiated and vaporized by laser beam,it should be at first to sufficiently expose the tumorthrough excision of lateral part of the nose and upper lip,and then treat it as described above,In patientswith cervical lymph node rnetastases,besides the laser treatment of the main tumor,surgical removal of thelymph nodes was performed.Among those 47 patients,no recurrence was found in 14(29.8%)cases fol-lowed up for 5 years,10(21.3%)cases for 3 years,12(25.5%)cases for 1 year,and failure in 11(23.4%)Cases.