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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 investigate the feasibility and clinical efficacy of laser surgery plus radiotherapy for recurrent and residual nasopharyngeal carcinoma. Methods A total of 35 patients with NPC were treated with laser plus radiotherapy (laser plus radiotherapy). Among them, 28 were recurrent and 7 were residual nasopharyngeal carcinoma. Radiotherapy alone (radiotherapy alone) 26 Cases, including 20 cases of recurrent cases, 6 cases of residual. There was no significant difference in the recurrence time and tumor TNM stage between the two groups. In the laser plus radiotherapy group, the tumor lesions were vaporized with a Nd:YAG laser (power: 50 W) under nasal endoscope and 60Co external radiation was administered for 2 weeks after surgery. The dose was 20-30 Gy. In the radiotherapy group, 60Co external irradiation was applied to the joints of the cervical surface, the prenasal field, and the tangential line behind the neck, and the dose was 40-60 Gy. The efficacy of nasopharyngeal tumors disappeared after 6 months of radiotherapy. Results The total disappearance rate of tumor in laser plus radiotherapy group was 65-7% (23/35), and the partial disappearance rate was 28-6 % (10/35). The complete disappearance rate of tumor in radiotherapy group was 15-4% (4/26). The partial disappearance rate was 34-6 % (9/26). The complete disappearance rate of tumors in the two groups was significantly different (χ2 = 11-2, P < 0-01). Conclusion Nasal endoscopic Nd:YAG laser surgery plus radiotherapy is an effective method to treat recurrent and residual nasopharyngeal carcinoma.