Pietrafitta J J, Carstens M H, Dwyer R M
Division of Surgery, University Hospital, Boston University School of Medicine, MA 02118.
Lasers Surg Med. 1987;7(6):487-90. doi: 10.1002/lsm.1900070608.
Malignant esophageal obstruction in 24 patients was treated using the neodymium:ytrium, aluminum, garnet laser. There were 15 males and nine females; the average age was 70.9 years. There were 17 adenocarcinomas and seven squamous cell carcinomas, with two of these being recurrent after radiation therapy. Tumor lengths ranged from 2.5-19.0 cm, with an average of 6.7 cm. The average energy delivered per centimeter of tumor was 6,309 joules for the squamous cell carcinomas and 5,598 for the adenocarcinomas. Energy delivered per treatment ranged from 3,152 to 70,527 joules. Total energy delivered per patient depended on the volume of tumor destroyed. Esophageal lumens increased from 3.4 to 16.7 mm, and 23 patients had their diets advanced, 22 to regular and one to soft solids. Reobstruction did not occur in patients who received adjunctive therapy after laser therapy. This consisted of chemotherapy in five, surgery in two, and radiation therapy in one. Complications consisted of aspiration pneumonia in three patients, including one who developed a tracheoesophageal fistula, and one documented and two suspected perforations. Hospital stay averaged 5.4 days overall and 3.5 days in those treated with the single-session technique. This increased to 8.0 days in patients with proven or suspected perforations. Endoscopic laser therapy is a safe and effective method for palliating esophageal cancer.
对24例恶性食管梗阻患者使用钕:钇铝石榴石激光进行治疗。其中男性15例，女性9例；平均年龄为70.9岁。有17例腺癌和7例鳞状细胞癌，其中2例为放射治疗后复发。肿瘤长度为2.5 - 19.0厘米，平均为6.7厘米。鳞状细胞癌每厘米肿瘤的平均能量输送为6309焦耳，腺癌为5598焦耳。每次治疗输送的能量为3152至70527焦耳。每位患者输送的总能量取决于被破坏的肿瘤体积。食管管腔从3.4毫米增加到16.7毫米，23例患者的饮食得到改善，22例恢复正常饮食，1例改为软食。激光治疗后接受辅助治疗的患者未发生再梗阻。辅助治疗包括5例化疗、2例手术和1例放射治疗。并发症包括3例吸入性肺炎，其中1例发生气管食管瘘，1例确诊穿孔，2例疑似穿孔。总体住院时间平均为5.4天，采用单次治疗技术的患者为3.5天。确诊或疑似穿孔的患者住院时间增至8.0天。内镜激光治疗是缓解食管癌的一种安全有效的方法。
