Norberto Lorenzo, Polese Lino, Angriman Imerio, Erroi Francesca, Cecchetto Attilio, D'Amico Davide F
Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Clinica Chirurgica Generale I, Università di Padova, Via Giustiniani 2, 35128 Padua, Italy.
World J Surg. 2004 Apr;28(4):350-4. doi: 10.1007/s00268-003-7332-x. Epub 2004 Mar 17.
We present the preliminary results obtained by our research group utilizing Nd:YAG and diode lasers to treat Barrett's esophagus (BE). A total of 15 patients with BE (mean age 58 years) underwent endoscopic laser therapy: 11 with intestinal metaplasia, 2 with low-grade dysplasia, and 2 with high-grade dysplasia. The mean length of BE was 4 cm (range 1-12 cm). Six of these patients also underwent antireflux surgery, and nine were prescribed acid-suppressive medication. Endoscopic Nd:YAG laser treatment was carried out from 1997 to 1999; thereafter, diode laser was employed. The mean follow-up of these patients after the first laser session was 28 months. Patients underwent a mean of 6.5 laser sessions (range 3-17 sessions), with no apparent complications. The mean energy per session was 1705 JJ. Only six of these patients (40%) showed complete endoscopic and histologic remission, but a mean of 77% (SD 23.8%) of the total metaplastic tissue in all these patients was ablated. The percentage of healed mucosa was higher in patients with short-segment BE (92%) ( p < 0.05) and in subjects treated by two or more laser sessions per centimeter of BE length (89%) ( p < 0.05). All four patients with dysplasia showed histologic regression to nondysplastic BE or to squamous epithelium, without recurrence during a mean follow-up of 30 months. The patients who underwent antireflux surgery and those prescribed pharmacologic treatment had similar results. Nd:YAG and diode laser treatment of BE is a safe, effective procedure; it required two sessions per centimeter of metaplasia; and it achieved complete regression of the dysplasia. Further studies are necessary to quantify its effect on cancer incidence.
我们展示了我们研究小组利用钕钇铝石榴石（Nd:YAG）激光和二极管激光治疗巴雷特食管（BE）所获得的初步结果。共有15例BE患者（平均年龄58岁）接受了内镜激光治疗：11例为肠化生，2例为低级别异型增生，2例为高级别异型增生。BE的平均长度为4厘米（范围1 - 12厘米）。其中6例患者还接受了抗反流手术，9例患者被开了抑酸药物。内镜Nd:YAG激光治疗于1997年至1999年进行；此后，采用了二极管激光。这些患者在首次激光治疗后的平均随访时间为28个月。患者平均接受了6.5次激光治疗（范围3 - 17次），无明显并发症。每次治疗的平均能量为1705焦耳。这些患者中只有6例（40%）在内镜和组织学上显示完全缓解，但所有这些患者中平均77%（标准差23.8%）的化生组织被消融。短段BE患者的愈合黏膜百分比更高（92%）（p < 0.05），以及每厘米BE长度接受两次或更多次激光治疗的患者中愈合黏膜百分比更高（89%）（p < 0.05）。所有4例异型增生患者在平均30个月的随访期间组织学均回归为无异型增生的BE或鳞状上皮，无复发。接受抗反流手术的患者和接受药物治疗的患者结果相似。Nd:YAG和二极管激光治疗BE是一种安全、有效的方法；每厘米化生需要两次治疗；并且实现了异型增生的完全消退。需要进一步研究来量化其对癌症发病率的影响。
