Mathus-Vliegen E M, Tytgat G N
Department of Gastroenterology and Hepatology, University of Amsterdam.
Endoscopy. 1990 Jan;22(1):17-23. doi: 10.1055/s-2007-1012780.
Eight years of experience with endoscopic Nd:YAG laser photocoagulation were analyzed in retrospect in an attempt to identify factors relating to both failures and complications of laser therapy, and to delineate its limits and pitfalls in benign and malignant tumors. Three hundred and seventy-eight patients were studied, including 42 with gastroesophageal cancer, 180 with colorectal adenoma and 156 with colorectal malignancy. Patients with gastroesophageal cancer (n = 42) were referred mainly for obstruction in esophageal cancer and for bleeding in gastric cancer, with successful palliation in 86 and 81%. Hemorrhage was the only complication seen, twice during and twice after treatment. Pain, heat and smoke-induced complaints and sometimes temporary increased dysphagia were mentioned. Two white-surfaced tumors did not react at all. Patients with colorectal adenoma (n = 150) were divided into groups according to the size of the lesion. Definitive, histologically documented eradication of adenomatous tissue was achieved in 43% of the extensive, in 69% of the intermediate, and in 97% of the small adenomas. Major complications, mainly stenosis and hemorrhage, occurred in 6.4%, 7.6% and none of the lesions, respectively, and minor complications were seen in 57.4, 30.8 and 13.8%, respectively. Stenosis appeared to be related only to prior electrocoagulation and to excessive delivery of energy. Post-treatment hemorrhage occurred at about day 7. In familial polyposis (n = 30) surveillance of the rectal stump was successful in 84%, with major and minor complications in 4% and 12%. In colorectal cancers (n = 156) treated for palliation of bleeding and obstruction, success was obtained in 91%. major complications (13%) consisted mainly of stenosis and perforation.(ABSTRACT TRUNCATED AT 250 WORDS)
对八年的内镜下钕钇铝石榴石激光光凝治疗经验进行了回顾性分析，旨在确定与激光治疗失败和并发症相关的因素，并阐明其在良性和恶性肿瘤治疗中的局限性和陷阱。共研究了378例患者，其中包括42例胃食管癌患者、180例结肠直肠腺瘤患者和156例结肠直肠癌患者。胃食管癌患者（n = 42）主要因食管癌梗阻和胃癌出血而接受治疗，食管癌梗阻缓解成功率为86%，胃癌出血缓解成功率为81%。出血是唯一观察到的并发症，治疗期间和治疗后各出现两次。有患者提到疼痛、热感、烟雾引起的不适，有时吞咽困难会暂时加重。有两个白色表面的肿瘤完全没有反应。结肠直肠腺瘤患者（n = 150）根据病变大小分组。广泛型腺瘤组织学证实完全根除的比例为43%，中型为69%，小型为97%。主要并发症（主要是狭窄和出血）分别发生在6.4%、7.6%的病变中，小型病变未出现主要并发症，轻微并发症分别见于57.4%、30.8%和13.8%的病变中。狭窄似乎仅与先前的电凝和能量过度输送有关。治疗后出血约在第7天发生。在家族性腺瘤性息肉病患者（n = 30）中，直肠残端监测成功率为84%，主要和轻微并发症发生率分别为4%和12%。在因出血和梗阻缓解而接受治疗的结肠直肠癌患者（n = 156）中，成功率为91%。主要并发症（13%）主要包括狭窄和穿孔。（摘要截断于250字）
