Ertan A, Zimmerman M, Younes M
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Am J Gastroenterol. 1995 Dec;90(12):2201-3.
We report the use of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser ablation to treat high-grade dysplasia and intramucosal esophageal adenocarcinoma associated with Barrett's esophagus in a patient who refused surgery. Throughout laser therapy, the patient received omeprazole 40 mg/day. After 1 1/2 yr, five laser treatments totaling 22,055 J given over a period of 13 months achieved squamous reepithelialization and absence of malignant transformation in the first area in which carcinoma was diagnosed. Squamous reepithelialization was maintained 1 yr later, confirming recent reports that photoablation plus omeprazole can achieve regression of Barrett's esophagus. During the last year of follow-up, a second contiguous area discovered to contain carcinoma was treated three times by photoablation, with a total of 13,164 J; biopsy showed only low-grade dysplasia in this area after two laser treatments totaling 8,108 J. No complications were seen during or after any of the laser sessions, and the patient remained asymptomatic 2 1/2 yr after the first photoablation and 3 yr after presentation.
我们报告了一名拒绝手术的患者，使用钕钇铝石榴石（Nd:YAG）激光消融术治疗与巴雷特食管相关的高级别异型增生和黏膜内食管腺癌的情况。在整个激光治疗过程中，患者每天服用40毫克奥美拉唑。经过一年半的时间，在13个月内总共进行了5次激光治疗，能量总计22055焦耳，首次诊断出癌症的区域实现了鳞状上皮再上皮化且未发生恶性转化。一年后鳞状上皮再上皮化得以维持，证实了近期的报道，即光消融联合奥美拉唑可使巴雷特食管消退。在随访的最后一年，发现第二个相邻区域含有癌，对其进行了3次光消融治疗，能量总计13164焦耳；在总计8108焦耳的两次激光治疗后，该区域活检仅显示低级别异型增生。在任何一次激光治疗期间或之后均未出现并发症，患者在首次光消融后2年半以及就诊后3年仍无症状。
