O'Connor J J
Section of Colon and Rectal Surgery, Suburban Hospital, Bethesda, Md.
South Med J. 1991 Apr;84(4):472-4.
Laser ablation and bipolar coagulation have been used to palliate rectal cancer and avoid surgery. Indications are distal metastatic disease, extensive local invasion, obstruction and bleeding from nonresectable rectal tumor, or refusal of surgery. From Jan 1, 1986, to Jan 1, 1989, I saw 26 patients who met those criteria; 19 already had metastatic disease and three repeatedly refused abdominoperineal resection. A two-laser approach using both CO2 and Nd:YAG lasers was used in patients with low-lying lesions; others were treated by the Nd:YAG laser only. For rectal tumors, bipolar esophageal tumor probes were used via the rigid sigmoidoscope. The number of laser sessions averaged three per patient, and the number of bipolar coagulation sessions averaged five per patient. Bleeding followed bipolar coagulation in one patient. There were no perforations in either treatment group, and no patient has required colostomy. Of the 19 patients who already had metastatic disease, 12 are still alive, the longest survival being 20 months. Of those medically unfit for surgery, three have died of coincidental disease, and one is alive with controlled rectal cancer after 16 months. All three patients who refused surgery are alive; the longest survival is 13 months.
激光消融和双极电凝已被用于缓解直肠癌并避免手术。适应症包括远处转移性疾病、广泛局部侵犯、梗阻以及不可切除直肠肿瘤的出血，或拒绝手术。从1986年1月1日至1989年1月1日，我诊治了26例符合这些标准的患者；其中19例已有转移性疾病，3例反复拒绝腹会阴切除术。低位病变患者采用二氧化碳激光和钕钇铝石榴石激光联合的双激光方法；其他患者仅接受钕钇铝石榴石激光治疗。对于直肠肿瘤，通过硬式乙状结肠镜使用双极食管肿瘤探头。每位患者的激光治疗次数平均为3次，双极电凝治疗次数平均为5次。1例患者在双极电凝后出现出血。两个治疗组均未发生穿孔，且无患者需要进行结肠造口术。19例已有转移性疾病的患者中，12例仍然存活，最长存活时间为20个月。在那些因身体状况不适合手术的患者中，3例死于并发疾病，1例在16个月后存活且直肠癌得到控制。3例拒绝手术的患者均存活；最长存活时间为13个月。
