背景与目的:后装近距离治疗常常用于早期鼻咽癌放射治疗后程加量,但常规施源器置入方法定位不准、重复性差,无法向咽旁追量。本研究采用在鼻窦内窥镜引导下进行咽旁插植后装放疗的新方法,旨在解决常规后装治疗的上述缺陷。方法:选择2005年9月至2006年8月初治和复发鼻咽癌外照射后仍有鼻咽粘膜下肿瘤残留超过1cm或/和咽旁浸润但侵犯范围较局限的患者23例,在鼻窦内窥镜引导下经鼻腔进行鼻咽及咽旁施源器插植术,术后经CT扫描定位并确认插植位置合格后,利用三维近距离治疗系统进行鼻咽、咽旁肿瘤靶区勾画、剂量优化和组织间近距离治疗,测量治疗前后施源器植入的深度,并观察近距离治疗的疗效及并发症。结果:施源器均准确插入肿瘤区,插植位置100%合格。插入和拔出施源器时粘膜下植入深度分别为(9.59±2.72)mm和(9.43±2.30)mm,两者差异无统计学意义(t=0.23,P>0.05);漂移长度为(0.75±0.75)mm。治疗后3个月内肿瘤完全消失,无肿瘤局部复发,无远处转移。随访3～15个月(中位随访时间6个月),随访率100%,无大出血、感染等手术并发症,无腭穿孔、鼻咽坏死等严重后装放疗并发症;3例鼻甲粘连,经分解后完全缓解。结论:经鼻窦内窥镜鼻咽、咽旁插植定位准确,固定良好,安全可行;对鼻咽癌放疗后鼻咽、咽旁残留病灶进行组织间近距离治疗近期疗效良好,无严重近期并发症。 BACKGROUND & OBJECTIVE: The post-loaded brachytherapy is often used in the post-radiation treatment of nasopharyngeal carcinoma in early stage. However, the conventional method of locating the applicator is not accurate and has poor reproducibility. In this study, a new method of placement and radiotherapy after parapharyngeal implantation guided by endoscopic sinus surgery was adopted to solve the above shortcomings of conventional post-treatment. Methods: Twenty-three patients with nasopharyngeal submucosal tumor residual more than 1cm or / and parapharyngeal infiltration after the initial radiotherapy and recurrent nasopharyngeal carcinoma were selected from September 2005 to August 2006, Under the guidance of nasoscope, the nasopharyngeal and parapharyngeal devices were implanted under the guide of the endoscope. After the CT scanning and positioning were confirmed and the position of implants was confirmed, the nasopharyngeal and parapharyngeal tumor target areas were drawn by the three-dimensional brachytherapy system. Dose optimization and brachytherapy were performed. The depth of implants before and after treatment was measured, and the curative effect and complications of brachytherapy were observed. Results: The applicators were accurately inserted into the tumor area and the implantation site was 100% qualified. The depths of submucosal implants were (9.59 ± 2.72) mm and (9.43 ± 2.30) mm, respectively, with no significant difference between the two groups (t = 0.23, P> 0.05) 0.75 ± 0.75) mm. The tumor completely disappeared within 3 months after treatment, no local tumor recurrence, no distant metastasis. The patients were followed up for 3 to 15 months (median follow-up time was 6 months). The follow-up rate was 100%. No complications such as hemorrhage and infection were found. There were no postoperative complications such as palatal perforation and nasopharyngeal necrosis. After the decomposition completely relieved. Conclusions: Nasopharyngeal and parapharyngeal transposition of the endoscopic sinus is accurate, safe and feasible. The nasopharyngeal and parapharyngeal residual lesions after nasopharyngeal carcinoma radiotherapy have good short-term effect and no recent serious complications disease.