Norberto L, Polese L, Angriman I, Erroi F, Cecchetto A, D'Amico D F
Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Clinica Chirurgica Generale I, Università di Padova, 35128 Padova, Italy.
Surg Endosc. 2005 Aug;19(8):1045-8. doi: 10.1007/s00464-004-2179-2. Epub 2005 May 19.
We analyze laser photoablation as an alternative treatment of large sessile polyps in inoperable patients.
Ninety-four colorectal polyps (mean diameter 3.09 +/- 2.7 cm, range 1-15 cm) were treated using high-energy lasers (Nd:YAG and diode). Grade of dysplasia was low in 51, high in 35, with focally invasive cancer in eight.
After 405 laser sessions (4.3 per polyp) five procedure-related complications were observed: two strictures, two bleedings, and one perforation. The last needed a surgical resection; the others were successfully treated by endoscopic therapy. Fifty-seven polyps (61%) were completely eradicated and the growth was controlled in all but two (98%). No degeneration was found after 28-month follow-up of treated adenomas with low- or high-grade dysplasia. Outcome of treatment was dependent on the dimension and grade of the dysplasia (p < 0.05), but not on the polyps' position (rectum or colon). Relief of rectal bleeding was obtained in 90%, of mucus discharge in 77%, and of tenesmus in 100% of cases.
Laser photoablation of colonic adenomas can be considered a valid procedure not only to relieve symptoms, but also to control the risk of degeneration in patients unfit for surgery or when surgical treatment is considered excessively invalidating.
我们分析激光光凝消融术作为无法手术患者的大型无蒂息肉的替代治疗方法。
使用高能激光（Nd:YAG和二极管）治疗94例大肠息肉（平均直径3.09±2.7 cm，范围1 - 15 cm）。51例发育异常程度为低级别，35例为高级别，8例有局灶性浸润癌。
在405次激光治疗疗程后（每个息肉4.3次），观察到5例与手术相关的并发症：2例狭窄、2例出血和1例穿孔。最后1例需要手术切除；其他通过内镜治疗成功处理。57例息肉（61%）被完全根除，除2例（98%）外所有息肉的生长均得到控制。对低级别或高级别发育异常的腺瘤进行28个月随访后未发现退变。治疗结果取决于发育异常的大小和级别（p < 0.05），但不取决于息肉的位置（直肠或结肠）。90%的病例直肠出血得到缓解，77%的病例黏液排出得到缓解，100%的病例里急后重得到缓解。
结肠腺瘤的激光光凝消融术不仅可被视为缓解症状的有效方法，而且对于不适合手术或手术治疗被认为过度致残的患者，还可用于控制退变风险。
