Eckhauser M L
Department of Surgery, Case Western Reserve University, Cleveland, Ohio.
World J Surg. 1992 Nov-Dec;16(6):1054-9. doi: 10.1007/BF02067061.
Surgical resection remains the therapy of choice for the treatment of potentially curable gastrointestinal tract (GI) malignancies. Many of these tumors are incurable at the time of diagnosis and therapy should be directed towards palliation with the intent of minimizing pain, bleeding, obstruction, and potential morbidity. Endoscopic laser therapy is uniquely applicable for the palliation of GI tumors and in selective instances may be appropriate for the treatment of early lesions. Eighty-six patients with GI malignancy have been treated at our institution since 1985. Thirty-one patients had advanced upper GI lesions (esophagus: 26, gastric: 3, duodenal: 1, and pancreatic: 1) and 55 patients had lower GI tumors (colon: 37 and rectal: 18). Pre-resectional recanalization for obstructing colorectal carcinomas obviating initial operative diversion was performed in 31 (56%) of 55 patients. Twenty-four patients had palliative laser therapy (obstruction: 17 and hemorrhage: 7) with resolution of their symptoms. There was 1 laser related perforation in the pre-resectional group and the overall complication rate was 1.2%. Endoscopic Nd:YAG and currently photodynamic laser therapy for GI tumors has proven to be an effective mode of therapy for advanced GI neoplasms with minimal morbidity. The utility of photodynamic therapy for the treatment of early stage esophageal and gastric cancers remains controversial.
手术切除仍然是治疗潜在可治愈的胃肠道（GI）恶性肿瘤的首选疗法。这些肿瘤中的许多在诊断时已无法治愈，治疗应旨在缓解症状，以尽量减少疼痛、出血、梗阻和潜在的发病率。内镜激光治疗特别适用于缓解胃肠道肿瘤，在某些特定情况下可能适用于早期病变的治疗。自1985年以来，我们机构共治疗了86例胃肠道恶性肿瘤患者。31例患者患有晚期上消化道病变（食管：26例，胃：3例，十二指肠：1例，胰腺：1例），55例患者患有下消化道肿瘤（结肠：37例，直肠：18例）。55例患者中有31例（56%）因梗阻性结直肠癌在术前进行了再通术，避免了最初的手术改道。24例患者接受了姑息性激光治疗（梗阻：17例，出血：7例），症状得到缓解。术前治疗组有1例与激光相关的穿孔，总体并发症发生率为1.2%。内镜下钕钇铝石榴石激光以及目前用于胃肠道肿瘤的光动力激光治疗已被证明是治疗晚期胃肠道肿瘤的一种有效治疗方式，发病率极低。光动力疗法治疗早期食管癌和胃癌的效用仍存在争议。
