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目的:探讨手术联合同步放、化疗治疗早期鼻咽癌的疗效。方法:将早期鼻咽癌患者按患者意愿分为手术组(31例)和常规组(73例)。手术组采用手术加同步放、化疗方案治疗,常规组采用同步放、化疗方案治疗。观察指标为:①5年生存率、无瘤生存率;②鼻咽部放射剂量;③口干症的发生率。结果:①总的5年随访率为97.12%,其中手术组失访1例,5年随访率为96.77%;常规组失访2例,5年随访率为97.26%;②104例患者的5年生存率为83.65%(87/104),局部复发率及远处转移率均为9.62%(10/104);③5年生存率和无瘤生存率手术组分别为96.77%(30/31)、93.55%(29/31),常规组分别为78.08%(57/73)、73.97%(54/73),2组比较均差异有统计学意义(均P<0.05);④手术组、常规组鼻咽部放射剂量分别为(63.90±5.56)Gy、(71.48±4.18)Gy,2组比较差异有统计学意义(P<0.05);⑤口干症的发生率手术组为22.58%(7/31),明显低于常规组的65.75%(48/73),2组比较差异有统计学意义(P<0.05)。结论:手术联合放、化疗治疗早期鼻咽癌,既可提高患者远期生存率,又可减少鼻咽部的放射剂量,降低放射并发症的发生,是早期鼻咽癌有效的综合治疗方案,值得进一步研究。
Objective: To investigate the efficacy of surgery combined with concurrent radiotherapy and chemotherapy for the treatment of early stage nasopharyngeal carcinoma. Methods: Patients with early nasopharyngeal carcinoma were divided into operation group (n = 31) and conventional group (n = 73) according to patients’ wishes. The operation group was treated with surgery plus concurrent radiotherapy and chemotherapy regimen, while the routine group was treated with concurrent radiotherapy and chemotherapy regimen. The observed indicators are: ① 5-year survival rate, tumor-free survival rate; ② nasopharyngeal radiation dose; ③ the incidence of dry mouth. Results: ① The total 5-year follow-up rate was 97.12%, of which 1 was lost to surgery in the operation group and 96.77% at 5 years. In the conventional group, 2 patients were lost to follow-up and the follow-up rate was 97.26% at 5 years. ② In 5 of 104 patients The survival rate was 83.65% (87/104), and the local recurrence rate and distant metastasis rate were both 9.62% (10/104). The 5-year survival rate and tumor-free survival rate were 96.77% (30/31) 93.55% (29/31) in the control group, 78.08% (57/73) in the conventional group and 73.97% (54/73) in the control group respectively. There were significant differences between the two groups (all P <0.05) (63.90 ± 5.56 Gy, 71.48 ± 4.18 Gy, respectively) (P <0.05); ⑤ The incidence of xerostomia in operation group was 22.58% (7 / 31), which was significantly lower than 65.75% (48/73) in the conventional group. The difference between the two groups was statistically significant (P <0.05). Conclusion: The combined operation of radiotherapy and chemotherapy for early stage nasopharyngeal carcinoma can not only improve the long-term survival rate of patients, but also reduce the dose of nasopharyngeal radiation and reduce the incidence of radiation complications. It is an effective comprehensive treatment for early stage nasopharyngeal carcinoma, Worth further study.