Hofstetter A, Böwering R, Keiditsch E, Frank F
Fortschr Med. 1983 Apr 14;101(14):625-7.
Only the neodymium-YAG laser is suitable for destroying tumors endoscopically, because it shows a very high transmission through water and a slight absorption in the tissue. It means scattering becomes important and leads to a homogeneous and uniform distribution of the radiation in the tissue producing a deep thermal effect. An examination of a section through a bladder wall under light microscope after neodymium-YAG laser irradiation shows a layered, sharply delimited coagulation necrosis that extends to all of the bladder wall layers and reaches the outermost zones. In this way it is possible to destroy not only the exophytic part of a tumor but also the tumor base in the tissue. Since 1976 we destroyed more than 4000 bladder tumors by laser application. For tumors on the ureter or kidney pelvis a special endoscope, described by Perez-Castro Ellendt and modified by us, can be used, if it is not possible to perform a conventional operation. It is reported about four cases of distal ureter tumors (GI-II) in patients who had refused an operation for removing the tumor bearing ureter segments. Now, for more than one and half a year all patients are free of tumors and the irradiated ureters show a good function. This novel procedure is not for routine, but for high risk patients or patients, who refuse an open operation.
只有钕钇铝石榴石激光适用于通过内窥镜破坏肿瘤，因为它在水中具有很高的透射率，而在组织中的吸收率很低。这意味着散射变得很重要，并导致辐射在组织中均匀分布，从而产生深部热效应。在钕钇铝石榴石激光照射后，在光学显微镜下检查膀胱壁切片，可见分层的、界限清晰的凝固性坏死，其延伸至膀胱壁的所有层并到达最外层区域。通过这种方式，不仅可以破坏肿瘤的外生部分，还可以破坏组织中的肿瘤基底。自1976年以来，我们通过激光应用摧毁了4000多个膀胱肿瘤。对于输尿管或肾盂上的肿瘤，如果无法进行传统手术，可以使用由佩雷斯-卡斯特罗·埃伦特描述并经我们改进的特殊内窥镜。据报道，有4例远端输尿管肿瘤（GI-II）患者拒绝手术切除带肿瘤的输尿管段。现在，一年半多来，所有患者都没有肿瘤，且照射过的输尿管功能良好。这种新方法并非用于常规情况，而是针对高危患者或拒绝接受开放手术的患者。
