Byrne D J, Lavelle-Jones M, Pringle R
Ninewells Hospital and Medical School, Dundee, UK.
J R Coll Surg Edinb. 1993 Feb;38(1):36-40.
Although radical excision remains the treatment of choice for rectal carcinoma and large rectal polyps, laser treatment of such tumours in patients unfit for surgery, as well as for those fit patients with small sessile rectal polyps, is a valid therapeutic option. In the present series 24 patients (16 males and 8 females; median age 78.5 years, range 59-91) had laser treatment--six for rectal carcinoma and 18 for benign rectal polyps. A Nd-YAG laser was used to treat all patients using either a rigid operating or a flexible sigmoidscope to gain access to the tumour. Debulking of large tumours with the diathermy snare before laser treatment was very helpful. In this series 50 to 70 watts of power for 2 to 5 s were used. Total doses of laser energy administered ranged from 414 to 26,117 joules and depended on the initial tumour size and also the amount of tumour that could be removed during preliminary debulking. There were no immediate post-treatment complications but one patient developed a rectovaginal fistula 3 months after laser treatment. Two carcinomas were completely ablated by laser treatment and the other four patients with rectal carcinoma had fair to excellent palliation. All but one of the polyps were completely cleared by laser therapy. Laser therapy seems superior to simple fulguration as three patients who had repeated fulgurations for large polyps without much success had their polyps dramatically improved by laser treatment.
尽管根治性切除仍然是直肠癌和大型直肠息肉的首选治疗方法，但对于不适合手术的患者以及适合手术的小型无蒂直肠息肉患者，激光治疗此类肿瘤是一种有效的治疗选择。在本系列研究中，24例患者（16例男性和8例女性；中位年龄78.5岁，范围59 - 91岁）接受了激光治疗，其中6例为直肠癌，18例为良性直肠息肉。使用Nd - YAG激光通过硬性手术器械或可弯曲乙状结肠镜进入肿瘤部位来治疗所有患者。在激光治疗前用高频电圈套器切除大型肿瘤非常有帮助。在本系列研究中，使用功率为50至70瓦，持续2至5秒。激光能量的总剂量范围为414至26117焦耳，这取决于初始肿瘤大小以及在初步切除过程中能够切除的肿瘤量。治疗后没有立即出现并发症，但有1例患者在激光治疗3个月后出现直肠阴道瘘。2例癌通过激光治疗完全消融，另外4例直肠癌患者的病情得到了较好至极好的缓解。除1例息肉外，所有息肉均通过激光治疗完全清除。激光治疗似乎优于单纯电灼，因为3例因大型息肉反复电灼但效果不佳的患者，其息肉经激光治疗后有显著改善。
