Jakobs R, Miola J, Eickhoff A, Adamek H E, Riemann J F
Department of Medicine C (Gastroenterology); Klinikum der Stadt Ludwigshafen gGmbH, Academic teaching Hospital of the University of Mainz, Ludwigshafen, Germany.
Z Gastroenterol. 2002 Aug;40(8):551-6. doi: 10.1055/s-2002-33414.
The treatment of advanced rectal cancer is still a challenge. We analysed the short-term success, treatment-related complications and the long-term outcome after laser palliation for rectal cancer.
Over a ten-years period eighty-three consecutive patients (median age 81 (46-94) yrs; 43 female) were treated mainly for obstructive symptoms or tumour bleeding. Laser palliation was performed using a Neodymium:Yttrium-Aluminium-Garnet (Nd:YAG) laser.
The immediate overall-success rate was 96.4 % (80 of 83 patients) and only one female received a diverting colostomy because of an inaccessible high-grade rectal stenosis, initially. During follow-up, eight additional patients had to undergo surgery on their rectal cancer because of treatment failures (most of them recurrent obstruction) or complications (long-term success rate: 86.7 % (72 of 83 pts.)). The median survival period was nine months. Patients treated for obstruction had more treatment sessions and had a higher rate of surgical palliation in comparison to those pts. therapied for bleeding. Major complications were seen in three patients (3.6 %). One patient died after rectal perforation following bougienage before laser treatment (overall mortality: 1.2 %).
Laser therapy is effective for the palliation of advanced rectal cancer with a high short-term and long-term success rate and only few complications. Laser treatment therefore is still a valuable alternative to newer endoscopic techniques and surgery.
晚期直肠癌的治疗仍然是一项挑战。我们分析了直肠癌激光姑息治疗后的短期疗效、治疗相关并发症及长期预后。
在十年期间，连续83例患者（中位年龄81（46 - 94）岁；43例女性）主要因梗阻症状或肿瘤出血接受治疗。使用钕：钇铝石榴石（Nd:YAG）激光进行激光姑息治疗。
即刻总体成功率为96.4%（83例患者中的80例），最初只有1例女性因高位直肠狭窄难以处理而接受了改道结肠造口术。在随访期间，另外8例患者因治疗失败（大多数为复发性梗阻）或并发症而不得不接受直肠癌手术（长期成功率：86.7%（83例患者中的72例））。中位生存期为9个月。与因出血接受治疗的患者相比，因梗阻接受治疗的患者治疗次数更多，手术姑息治疗率更高。3例患者（3.6%）出现严重并发症。1例患者在激光治疗前扩张术后直肠穿孔死亡（总死亡率：1.2%）。
激光治疗对晚期直肠癌的姑息治疗有效，短期和长期成功率高，并发症少。因此，激光治疗仍然是较新的内镜技术和手术的一种有价值的替代方法。
