Objective To evaluate the treatment effect of later course accelerated hyperfractionated radiotherapy with chemotherapy for stage Ⅲ and ⅣA nasopharyngeal carcinoma. Methods 116 patients with stage Ⅲand Ⅳ s nasopharyngeat carcinoma were randomly divided into three groups: the conventional fractionation radiotherapy(CFR, 38 cases), the concurrent radiochemotherapy group(CCRT, 39 cases) and the later course accelerated hyperfractionated radiotherapy combined with chemotherapy group (LCAF+CT, 39cases). CFR group was treated with 60Co γ rays and X rays. When the patients had received the dose of 36～38 Gy through composite faciocervical fields, changed into preauricular fields, the total dose was 70 ～75 Gy.And the total dose of cervical metastasis lymph nodes were 70～80 Gy. CCRT group was treated with DDP and 5-Fu. LCAF+CT group was treated with accelerated hyperfractionated radiotherapy. When the dose of composite faciocervical fields had reached 36～38 Gy, changed the fields and treated with accelerated hyperfractionated radiotherapy, 1.3 Gy/fraction, twice daily. The total dose was 69.8～75 Gy. And the chemotherapy drugs was similar to CCRT group. Results The positive response rate among LCAF+CT, CCRT and CFR groups were 94.9 %, 89.7 %, 76.3 % respectively. The complete response rate in the nasopharyn of LCAF+CT group was higher than CFR group(P ＜0.05). The local control rates of one, two and three year of three groups were 100 %, 97.4 %, 89.5 %, 94.9 %, 84.6 %, 68.4 % and 89.7 %, 74.4 %, 57.9 %respectively; and the survival rates of one, two and three year of three groups were 100 %, 92.3 %, 84.2 %;89.7 %, 84.6 %, 71.0 % and 79.5%, 76.9 %, 57.9 % respectively. There were obvious difference between LCAF+CT and CCRT groups in local control rate and survival rate. But there were no difference between LCAF+CT group and CCRTgroup, and also between CCRT group and CFR group. Conclusion The later course accelerated hyperfraetionated radiotherapy combined with chemotherapy can promote disappearance of primary lesion and improve the local control rate and survival rate of patients with stage Ⅲand ⅣA nasopharyngeal carcinoma.

Objective To compare the short-term clinical effects of unilateral dual-channel endoscopic discectomy(UBED)and percutaneous endoscopic intervertebral discectomy(PEID)in the treatment of L5S,Lumbar disc herniation,LDH.Methods From January 2019 to January 2021,a total of 57 cases of L5S,LDH treated by UBED or PEID were analyzed retrospectively,including 30 cases in UBED group and 27 cases in PEID group.The operation time,intraoperative fluoroscopy times,postoperative hospitalization days and surgical complications were compared between the two groups.The visual analogue scale(VAS)and oswestry disability index(ODI)were used to compare the postoperative quality of life of the two groups,and the modified MacNab criteria was used to evaluate the clinical efficacy in the last follow-up.Results The operation time of UBED group and PEID group was(75.30±8.44)minutes and(68.37±4.63)minutes,respectively,and the difference between the two groups was statistically significant(P＜0.05).VAS and ODI of 1 week,3 months,1 year and 1.5 years after surgery in 2 groups were significantly decreased compared with those before surgery,with statistical significance(P＜0.05).The VAS score of low back pain in UBED group was higher than that in PEID group[(3.87±1.14)points vs(2.70±0.67)points]at 1 week after surgery(P＜0.05),and there was no significant difference in VAS and ODI at the other time points(P＞0.05).There was no statistical difference in the results of modified MacNab criteria in the last follow-up(P＞0.05).There were 2 cases of dural tear in PEID group,1 case of dural tear in UBED group and 1 case of temporary nerve root injury in PEID group after operation,all of which were cured after symptomatic treatment.Conclusion Compared with PEID,UBED has a longer operation time,more trauma and more obvious low back pain in the short term after operation.The short-term curative effect of the two operations on L5S1 LDH is similar,the incidence of complications is low,and the times of fluoroscopy are few.Both operations are safe and effective.