Bown S G
Endoscopy. 1986 Sep;18 Suppl 3:26-31. doi: 10.1055/s-2007-1018438.
Most oesophageal cancers are incurable by the time the diagnosis is made. Treatment is therefore often palliative, and endoscopic modalities cause considerably less general upset to the patient than surgery, radiotherapy or chemotherapy. Nd:YAG laser recanalisation of advanced obstructing cancers is safe and effective for exophytic tumours that are endoscopically accessible in over 80% of cases. The risk of perforation is less than half that associated with insertion of a perforation is less than half that associated with insertion of a prosthesis, although it is higher in patients who have previously been treated by radiotherapy. After laser treatment, half the patients are able to maintain adequate nutrition until the time of their death from disseminated disease. The other half get further dysphagia due to recurrent exophytic tumour or compression from extrinsic tumour. A few develop fibrous stricturing in the laser treated area. However, many of these recurrences can be treated again with the laser or by dilation with or without a prosthesis. The quality of swallowing is better after laser treatment, as any residual oesophageal muscle function in that area can be used (not possible with a prosthesis), although several treatment sessions are usually required. In the future, the precision of laser effects may make it possible to safely ablate early tumours in their entirety.
大多数食管癌在确诊时已无法治愈。因此，治疗通常是姑息性的，与手术、放疗或化疗相比，内镜治疗对患者造成的全身不适要小得多。对于80%以上内镜可及的外生性晚期梗阻性癌症，钕钇铝石榴石激光再通术是安全有效的。穿孔风险不到置入假体相关风险的一半，不过先前接受过放疗的患者穿孔风险更高。激光治疗后，一半患者能够维持足够的营养直至死于播散性疾病。另一半患者则因外生性肿瘤复发或外部肿瘤压迫而再次出现吞咽困难。少数患者在激光治疗区域出现纤维性狭窄。然而，这些复发中的许多情况可以再次用激光治疗，或通过扩张（有无置入假体）进行治疗。激光治疗后吞咽质量更好，因为该区域任何残留的食管肌肉功能都可以利用（置入假体则无法做到），尽管通常需要多次治疗。未来，激光效应的精准性可能使安全地完全消融早期肿瘤成为可能。
