Aly Emad A H, Burgess Phillip
Unit of Surgical Gastroenterology, Princess Margaret Hospital, Swindon, UK.
Dig Surg. 2002;19(1):3-8. doi: 10.1159/000051998.
Endoscopic laser treatment offers rapid relief from dysphagia. The major drawback of laser therapy is the need for repeated treatment at 4- to 6-week intervals. Laser therapy is often done in tertiary referral centres and is said to require special expertise that is not available in many peripheral hospitals. For smaller centres, intubation is likely to be the only treatment option even though it gives less quality of palliation.
To report the experience of a district general hospital in laser treatment of malignant dysphagia.
A retrospective study on patients who had laser therapy for relief from malignant dysphagia from march 1995 to January 2000 was performed in a district general hospital in the UK.
Forty patients (25 males and 15 females) with histologically proven oesophageal carcinoma were unsuitable for surgical resection. Trainees, under supervision, did 20% of the sessions. Treatment was done on a day case basis with no outpatient follow-up. The patients had direct access to the service whenever dysphagia got worse. The median number of sessions per patient was 4 (range 1-13). The median palliation period per session was 7 (range 1-32) weeks. The median total palliation period was 7 months. There was no procedure-related mortality.
Laser therapy is a safe, easy to teach and learn technique for relief from malignant dysphagia. It can be done on a day case basis with minimum need for follow-up and hospital visits. Such a service could be provided in a district general hospital set-up once equipment and experience are available, thus saving patients from having to travel to specialist units.
内镜激光治疗可迅速缓解吞咽困难。激光治疗的主要缺点是需要每隔4至6周重复治疗。激光治疗通常在三级转诊中心进行，据说需要特殊的专业技能，而许多基层医院并不具备。对于较小的中心而言，插管可能是唯一的治疗选择，尽管其缓解质量较低。
报告一家地区综合医院在恶性吞咽困难激光治疗方面的经验。
对1995年3月至2000年1月在英国一家地区综合医院接受激光治疗以缓解恶性吞咽困难的患者进行了一项回顾性研究。
40例经组织学证实为食管癌的患者（25例男性和15例女性）不适合手术切除。20%的治疗由在监督下的实习生完成。治疗在日间进行，无需门诊随访。吞咽困难加重时，患者可直接接受该治疗服务。每位患者治疗的中位数次数为4次（范围1 - 13次）。每次治疗的中位数缓解期为7周（范围1 - 32周）。总缓解期的中位数为7个月。无与治疗相关的死亡病例。
激光治疗是一种安全、易于教授和学习的缓解恶性吞咽困难的技术。它可以在日间进行，随访和住院需求最少。一旦具备设备和经验，地区综合医院就可以提供这样的服务，从而使患者无需前往专科单位就诊。
