Cavaliere S, Venuta F, Foccoli P, Toninelli C, La Face B
Centro di Endoscopia e Laserterapia dell'Apparato Respiratorio, Spedali Civili, Brescia, Italy.
Chest. 1996 Dec;110(6):1536-42. doi: 10.1378/chest.110.6.1536.
We report our 13-year experience with endoscopic treatment of malignant obstructions of the airway by Nd:YAG laser, stents, and intraluminal brachytherapy in 2,008 patients. We performed 2,610 laser resections in 1,838 patients, 66 high dose rate brachytherapies, and we placed 393 tracheobronchial silicone stents in 306 patients. We used the rigid bronchoscope in 96% of the laser procedures and in all cases requiring stent placement; general anesthesia was given to 90% of these patients. Endobronchial radiotherapy was performed under local, anesthesia. In 93% of patients undergoing laser resection, we obtained an immediate patency of the airway with consequent improvement of quality of life. The median time between the first and second laser treatment was 102 days, being longer in the case of stent placement (when required) or in association with brachytherapy. Even if endoscopic treatment should be considered only for palliation, laser vaporization could be curative in case of in situ carcinoma. Since 1983, we have treated 23 such lesions in 17 patients and up to now, none has recurred. Finally, endoscopic resection may allow a better assessment of the true extent of the tumor, shifting to surgery patients originally considered to have inoperable disease or allowing lung-sparing operations (21 and 18 patients of our series, respectively). The total mortality rate was 0.4% (12 patients over 2,798 treatments; 2,710 Nd:YAG laser + 151 stents without laser + 37 brachytherapies without laser) in the first week after the procedures, and was mainly related to cardiovascular problems and respiratory failure. In conclusion, endoscopic resection of lung malignancies is rapid, effective, repeatable, and complementary to other treatments; although it should be considered only palliative, laser resection could be curative in patients with in situ carcinomas and early cancers. Laser, stents, and endoluminal brachytherapy should be available in all centers with major experience; a well-trained team is mandatory to plan the most appropriate treatment and manage any possible complication.
我们报告了在2008例患者中应用钕钇铝石榴石（Nd:YAG）激光、支架及腔内近距离放射治疗对气道恶性梗阻进行内镜治疗的13年经验。我们对1838例患者进行了2610次激光切除术，66次高剂量率近距离放射治疗，并为306例患者置入了393个气管支气管硅胶支架。96%的激光手术及所有需要置入支架的病例均使用硬支气管镜；这些患者中90%接受全身麻醉。支气管内放射治疗在局部麻醉下进行。93%接受激光切除术的患者气道立即通畅，生活质量随之改善。首次与第二次激光治疗的中位间隔时间为102天，在需要置入支架（若有需要）或联合近距离放射治疗的情况下间隔时间更长。即使内镜治疗仅应被视为姑息性治疗，但对于原位癌，激光汽化可能具有治愈性。自1983年以来，我们已对17例患者的23处此类病变进行了治疗，截至目前，无一例复发。最后，内镜切除术可更好地评估肿瘤的真实范围，使原本被认为无法手术的患者转而接受手术治疗，或可行肺保留手术（本系列分别为21例和18例患者）。术后第一周的总死亡率为0.4%（2798次治疗中有12例患者；2710次Nd:YAG激光治疗+151次未行激光的支架置入+37次未行激光的近距离放射治疗），主要与心血管问题和呼吸衰竭有关。总之，肺恶性肿瘤的内镜切除术快速、有效、可重复，且是其他治疗的补充；尽管仅应被视为姑息性治疗，但激光切除术对原位癌和早期癌症患者可能具有治愈性。所有经验丰富的中心均应具备激光、支架及腔内近距离放射治疗技术；必须有一支训练有素的团队来规划最合适的治疗方案并处理任何可能的并发症。
