Rutgeerts P, Vantrappen G, Broeckaert L, Muls M, Geboes K, Coremans G, Janssens J
Department of Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
Gastrointest Endosc. 1988 Mar-Apr;34(2):87-90. doi: 10.1016/s0016-5107(88)71269-9.
Endoscopic laser therapy (ELT) for palliation of cancer of the esophagus and the gastroesophageal junction was evaluated in 31 patients with far advanced disease. Initial technical success (94%) and initial improvement of symptoms (81%) were comparable to data reported previously. Complications were bleeding (6%), sepsis (6%), and tracheoesophageal fistula (6%). This analysis, however, addressed the impact of ELT on the remaining life of the patients. In 9 patients (29%) ELT was the only palliative alternative, and in 7 of these patients a fair functional success was achieved. In 13/21 (63%) of the patients with good initial functional result palliation could be preserved by repeated ELT until death from cachexia. Eight patients, however, were intubated in the follow-up period because of failure to keep the esophagus open. The dysphagia-free interval was only 4 weeks, and repeated ELT became progressively more difficult because of increased tumor load and increasing debility of the patient. 32% of the patients experienced ELT as more difficult than repeated dilations. Our data also suggest that duration of palliation after ELT alone lasts longer than palliation after dilation followed by ELT. Results of ELT were best in patients with recurrent cancer at the esophagogastric or esophagojejunal anastomosis.
对31例晚期食管癌和胃食管交界癌患者进行了内镜激光治疗（ELT）以缓解症状。初始技术成功率（94%）和症状初始改善率（81%）与先前报道的数据相当。并发症包括出血（6%）、脓毒症（6%）和气管食管瘘（6%）。然而，本分析探讨了ELT对患者剩余生命的影响。9例患者（29%）中ELT是唯一的姑息治疗选择，其中7例患者取得了一定的功能成功。在初始功能结果良好的21例患者中的13例（63%），通过重复ELT可维持姑息治疗直至因恶病质死亡。然而，8例患者在随访期间因食管未能保持通畅而进行了插管。无吞咽困难间隔仅4周，由于肿瘤负荷增加和患者身体日益虚弱，重复ELT变得越来越困难。32%的患者认为ELT比重复扩张更困难。我们的数据还表明，单纯ELT后的姑息治疗持续时间比扩张后再进行ELT的姑息治疗持续时间更长。ELT在食管胃或食管空肠吻合口复发癌患者中的效果最佳。
