Liu J S, Amemiya R, Chung F M, Tsuboi M, Saito H, Matsushima Y, Hayashi N, Oho K, Hayata Y
Department of Surgery, Tokyo Medical College, Japan.
J Clin Laser Med Surg. 1991 Feb;9(1):63-70. doi: 10.1089/clm.1991.9.63.
In Japan, the first bronchoscopic Nd:YAG laser applied clinically was performed in our institute 10 years ago, and based on this decade of experience, the indications, effectiveness, and limitations were studied. Between 1980 and 1989, a total of 202 cases were treated by Nd:YAG laser in our institute. Among them, 94 (46.5%) cases were primary lung cancers, 10 (5.0%) cases were primary tracheal malignancies, 56 (27.7%) cases were metastatic tracheal tumors, 6 (3.0%) cases were benign tracheal tumors, and 36 (17.8%) cases were nontumorous tracheal lesions. The indications for Nd:YAG laser therapy were defined as emergency widening of airway, curative treatment, reduction of tumor size, nontumorous benign lesions, and hemostasis. The desired therapeutic effects were obtained in 55/58 (94.8%) for emergency airway widening, 22/27 (81.5%) for curative treatment, 69/88 (78.4%) for reduction of tumor size, and 48/68 (70.6%) for nontumorous benign lesions. While performing Nd:YAG laser treatment, some limitations, such as poor residual pulmonary function, tumor size, tumor depth, cartilage structure, granulation, and stricture length, were encountered. Since bronchoscopic Nd:YAG laser treatment has become a well-established therapeutic modality for tracheobroncheal lesions, areas to be addressed in the future are the training of bronchoscopic laser therapists and research on the extension of applications. To increase the range of clinical applications, it is hoped that makers of laser systems will provide tunable wavelength machines at reduced cost.
在日本，我院于10年前首次将支气管镜下钕钇铝石榴石激光应用于临床，并基于这十年的经验对其适应证、有效性及局限性进行了研究。1980年至1989年间，我院共对202例患者进行了钕钇铝石榴石激光治疗。其中，原发性肺癌94例（46.5%），原发性气管恶性肿瘤10例（5.0%），转移性气管肿瘤56例（27.7%），良性气管肿瘤6例（3.0%），非肿瘤性气管病变36例（17.8%）。钕钇铝石榴石激光治疗的适应证定义为气道紧急扩张、根治性治疗、肿瘤体积缩小、非肿瘤性良性病变及止血。紧急气道扩张55/58例（94.8%）、根治性治疗22/27例（81.5%）、肿瘤体积缩小69/88例（78.4%）、非肿瘤性良性病变48/68例（70.6%）均取得了预期的治疗效果。在进行钕钇铝石榴石激光治疗时，遇到了一些局限性，如肺功能残余差、肿瘤大小、肿瘤深度、软骨结构、肉芽组织及狭窄长度等。由于支气管镜下钕钇铝石榴石激光治疗已成为气管支气管病变成熟的治疗方式，未来需要解决的领域是支气管镜激光治疗师的培训及应用扩展研究。为扩大临床应用范围，希望激光系统制造商能以降低的成本提供可调谐波长的设备。
