Walfisch S, Stern H, Ball S
Soroka Medical Centre, Beer Sheva, Israel.
Dis Colon Rectum. 1989 Dec;32(12):1060-4. doi: 10.1007/BF02553882.
Conventional treatment for colonic obstruction due to cancer or benign anastomotic strictures in high-risk patients or unresectable cases in some form of colostomy. This procedure has the negative aspects of requiring a general anesthetic and leaves the infirm patient with a stoma that they cannot easily attend to. Ablation of tumor by Nd-Yag laser has been available for several years, with passage of the laser fiber through a colonoscope. To evaluate the role of laser photocoagulation in the palliation of colorectal tumors or benign strictures, the authors summarized their initial experience, trying to define the indications, various methods of treatment, and complication rate in these patients. This technique is difficult to perform and has the added risk of intestinal perforation but does obviate anesthetic and surgical risks. Seven patients with recurrent metastatic colorectal obstruction, three patients with benign colonic strictures, and two patients with large villous tumors were treated with Nd-Yag laser passed via the colonoscope. The mean age was 71 years (range, 52 to 86 years). Five patients received sedatives only, six patients received epidural anesthetic, and one had a general anesthetic. The average total energy used was 3702 joules on noncontact fibers, and the average number of pulses was 126. Distance of the lesion from the anal margin ranged from 0.5 to 30 cm. Ten of twelve tumors were within 15 cm of the dentate line. In the most distal lesions, manual debulking with biopsy forceps facilitated the laser treatment. Symptomatic relief was achieved in all patients. One patient required a colostomy one month after treatment because of incontinence. Another patient needed a resection of a benign stricture after three laser treatments. Other than one case of microperforation, treated conservatively with antibiotics, no other complications occurred and there was no mortality. The authors believed that the Nd-Yag laser plays a specific role in the treatment of high-risk patients.
对于高危患者因癌症或良性吻合口狭窄导致的结肠梗阻或某些不可切除病例，常规治疗方式是某种形式的结肠造口术。该手术的负面之处在于需要全身麻醉，且让体弱患者带有一个他们难以照料的造口。通过将钕 - 钇铝石榴石（Nd - Yag）激光光纤经结肠镜插入来消融肿瘤已有数年历史。为评估激光光凝在缓解结直肠肿瘤或良性狭窄方面的作用，作者总结了他们的初步经验，试图明确这些患者的适应证、各种治疗方法及并发症发生率。这项技术操作困难且有肠穿孔的额外风险，但确实避免了麻醉和手术风险。7例复发性转移性结肠梗阻患者、3例良性结肠狭窄患者以及2例大的绒毛状肿瘤患者接受了经结肠镜插入Nd - Yag激光治疗。平均年龄为71岁（范围52至86岁）。5例患者仅接受了镇静剂，6例患者接受了硬膜外麻醉，1例接受了全身麻醉。非接触式光纤平均总能量使用为3702焦耳，平均脉冲数为126次。病变距肛缘距离为0.5至30厘米。12个肿瘤中有10个位于齿状线15厘米范围内。在最远端病变中，用活检钳手动减瘤有助于激光治疗。所有患者均实现了症状缓解。1例患者在治疗后1个月因失禁需要行结肠造口术。另1例患者在3次激光治疗后需要切除良性狭窄。除1例经抗生素保守治疗的微小穿孔外，未发生其他并发症，也无死亡病例。作者认为Nd - Yag激光在高危患者的治疗中发挥着特定作用。
