Kohler B, Riemann J F
Medizinische Klinik C, Klinikum der Stadt Ludwigshafen am Rhein.
Leber Magen Darm. 1988 Aug;18(4):177-83.
Endoscopic laser therapy today is representing a promising branch in gastroenterology. Accepted indications are palliative recanalisation of tumor stenoses in the upper GI-tract and the rectosigmoidal part as well as bleeding GI-lesions. Reopening of tumor stenoses is possible in 90-95% of the cases with a low complication rate. Similar results are obtained with endocavital tumor destruction in the stomach and the rectum. Stop of GI-bleeding can be achieved equally effective by alternative methods like electrocoagulation and sclerotherapy. Only the tumor bleeding is better controlled by laser. Benign stenoses may be treated with laser as well, however conventional endoscopic techniques reveal similar results. Limits of laser therapy should be kept in mind. Uncritical use has to be avoided. Prior to laser therapy necessary diagnostic procedures have to be evaluated in order not to miss curative tumor surgery. An interdisciplinary approach including surgeons and radiologists is mandatory to obtain optimal results. Palliation today is the most important indication for laser therapy. Whether early cancer of the stomach will become an indication for curative treatment using photodynamic therapy remains to be seen in the future.
如今，内镜激光治疗是胃肠病学中一个很有前景的分支。公认的适应证包括对上消化道和直肠乙状结肠部位的肿瘤狭窄进行姑息性再通以及治疗胃肠道出血性病变。90%至95%的肿瘤狭窄病例能够实现再通，且并发症发生率较低。在胃和直肠的腔内肿瘤破坏方面也能取得类似结果。通过电凝和硬化疗法等替代方法，同样可以有效地止住胃肠道出血。只有肿瘤出血能被激光更好地控制。良性狭窄也可以用激光治疗，不过传统的内镜技术也能取得类似效果。必须牢记激光治疗的局限性。应避免不加批判地使用。在进行激光治疗之前，必须评估必要的诊断程序，以免错过肿瘤根治性手术。必须采取包括外科医生和放射科医生在内的多学科方法，以获得最佳效果。如今，姑息治疗是激光治疗最重要的适应证。早期胃癌是否会成为使用光动力疗法进行根治性治疗的适应证，未来还有待观察。
