立体定向放射治疗鼻咽癌后复发或病变残存的研究

目的 评价立体定向放射治疗对鼻咽癌放疗后复发或病变残存的疗效。方法 对50例鼻咽癌放疗后复发或病变残存的患者进行了立体定向放射治疗（X－刀）。按1992年福州会议分期，Ⅰ期0％，Ⅱ期10．5％，Ⅲ期69．2％，Ⅳ期20．3％，外照射鼻咽部DT6800－7000cGY/7-8周。Ⅲ，Ⅳ期病例（89．5％）加用化疗VF或POF方案2－4周期。X－刀治疗患者的选择为经足量外照射后2－4周鼻咽部及咽旁间隙仍有肿瘤残存的或治疗半年后发现鼻咽部复发的各期患者。采用西门子MD－77直线加速器及深圳柯瑞特XST－SYSX线立体定向治疗系统进行治疗。一般600－800cGY/次，共3次，间隔7天。结果 1年生存率为100％，3年生存率为94％。生存质量评定KPS评分无明显下降。肿瘤总控制率88％（44／50），其中完全消失46％（23／50），明显缩小26％（13／50），缩小16％（8／50）。结论 鼻咽癌的分次性立体定向放射治疗是采用高精度、高剂量的治疗方式作为一个“挽救性治疗”的手段，是治疗鼻咽癌放疗后残存或肿瘤复发的有效方法之一。

A research of stereotactic radiotherapy on nasopharyngeal carcinoma the recurrent and residual lesions after radiotherapy

Objective To investigate the clinical application of the physiological permanent cardiac pacing.Methods 21 patients (14 males and 7 females) with age between 42 to 81 years, 10 with sick sinus syndrome, 9 with advanced atrioventricular block, 2 with trifascicular block, were implanted by DDDR (8 cases ) , DDD (10 cases ), AAI (1 case ) and VVIR (2 cases ) respectively. Results All implanted physiological cardiac pacemakers accounted for 50 percent of the total implanted pacemakers, dual chamber pacemakers for 42.9% and rate-adaptive pacemakers for 23.8%. The atrial and /or ventricular electrodes were implanted in right atrial appendage or right ventricular apex through the subclavian vein. The pacing threshold, electrode impedance and P or R wave amplitude was measured satisfactorily. Conclusion Physiological permanent cardiac pacing was an ideal pacing mode