Shankar S, George P J, Hetzel M R, Goldstraw P
Department of Thoracic Surgery, Middlesex Hospital, London.
Thorax. 1990 Jun;45(6):493-5. doi: 10.1136/thx.45.6.493.
In our patients with tumour affecting the trachea or carina elective surgery was carried out after endoscopic laser treatment. Laser treatment was performed as an emergency procedure in three of the patients, who presented with impending asphyxia; the improvement provided time in which to assess the disease, withdraw corticosteroids, and treat infection. The fourth patient was treated with the laser for life threatening haemoptysis, but further bleeding made it necessary to tamponade the tumour with a cuffed endotracheal tube for 24 hours. Elective resections of the trachea (three cases) and carina (one case) were performed successfully four to eight weeks after laser treatment. Frozen sections of the resection margins were clear in all cases and paraffin sections subsequently confirmed the localised nature of the lesions. All patients are alive and well with no evidence of tumour recurrence after 18 months to 4 years. Laser therapy appears to be an ideal preoperative treatment for patients with impending asphyxia but it may be of limited value in controlling very brisk haemorrhage.
在我们患有影响气管或隆突肿瘤的患者中，择期手术在内镜激光治疗后进行。激光治疗在3例即将窒息的患者中作为紧急手术实施；其改善效果为评估病情、停用皮质类固醇和治疗感染赢得了时间。第4例患者因危及生命的咯血接受激光治疗，但进一步出血使得有必要用带气囊的气管内导管填塞肿瘤24小时。激光治疗4至8周后成功进行了气管（3例）和隆突（1例）的择期切除术。所有病例切除边缘的冰冻切片均清晰，随后石蜡切片证实了病变的局限性。所有患者存活良好，18个月至4年后均无肿瘤复发迹象。激光治疗似乎是即将窒息患者理想的术前治疗方法，但在控制非常活跃的出血方面可能价值有限。
