Gelb A F, Epstein J D
West J Med. 1984 Mar;140(3):393-7.
We administered 45 Nd-YAG laser treatments in 29 patients (18 men) aged 39 to 82 years who had lung malignancy; 26 patients had primary non-oat cell lung cancer and three had metastatic airway malignancy. In all, 25 of the patients had been previously treated with combination(s) of surgical procedure, radiation therapy and chemotherapy. Indications for laser treatment included endobronchial airway obstruction with uncontrolled cough, hemoptysis, dyspnea or unresolved atelectasis-pneumonia. Of 15 patients with partially occluded tracheobronchial airway tumors, immediate palliative relief was achieved in 13 patients and lasted one to six months after a single treatment. In this group there was one postoperative death related to respiratory failure and two patients subsequently died of massive pulmonary hemorrhage. However, of 14 patients with totally obstructed airways, immediate palliative relief was achieved in only five patients and this lasted three weeks to three months after a single treatment. In this group there were two postoperative deaths related to progressive respiratory failure; in one case it was associated with endobronchial combustion of the fiberoptic bronchoscope. All three patients in both groups who died of respiratory failure were in acute respiratory distress and terminally ill before the procedure. These findings suggest that Nd-YAG laser therapy may be most beneficial in patients with partially rather than totally occluded airways due to lung malignancy.
我们对29例年龄在39至82岁之间的肺癌患者（18例男性）进行了45次钕钇铝石榴石（Nd-YAG）激光治疗；26例患者患有原发性非小细胞肺癌，3例患有转移性气道恶性肿瘤。总共有25例患者先前接受过手术、放疗和化疗的联合治疗。激光治疗的适应证包括支气管内气道阻塞伴无法控制的咳嗽、咯血、呼吸困难或未缓解的肺不张-肺炎。在15例气管支气管气道肿瘤部分阻塞的患者中，13例患者立即获得姑息性缓解，单次治疗后缓解持续1至6个月。该组中有1例术后死亡与呼吸衰竭相关，2例患者随后死于大量肺出血。然而，在14例气道完全阻塞的患者中，仅5例患者立即获得姑息性缓解，单次治疗后缓解持续3周3个月。该组中有2例术后死亡与进行性呼吸衰竭相关；1例与纤维支气管镜的支气管内燃烧有关。两组中所有3例死于呼吸衰竭的患者在手术前均处于急性呼吸窘迫且病情晚期。这些发现表明，对于因肺恶性肿瘤导致气道部分而非完全阻塞的患者，Nd-YAG激光治疗可能最为有益。
