Abdel-Wahab M, Gad-Elhak N, Denewer A, El-Ebidy G, Sultan A, Abou-Elenin A, Fathy O, Abou-Zid M, El-Ghawalby N, Ezzat F
Gastroenterology Surgical Center, Mansoura University, Egypt.
Hepatogastroenterology. 1998 Sep-Oct;45(23):1509-15.
BACKGROUND/AIMS: The present study was designed to evaluate the treatment of malignant dysphagia by laser palliation.
Between November 1994 and May 1997, 104 patients with esophageal carcinoma were subjected to endoscopic palliation with Nd-YAG laser. They were 83 men and 21 women with mean age 57+ 6.32 years. The majority of cases (94%) presented with difficulty in swallowing. Patients were treated at one-week intervals until benefit was achieved.
A tumor mass was observed in the lower third of the esophagus in 75 (72%) patients. The tumor mean length was 6 cm (range 3-10 cm). Histology revealed that 74 (71%) patients had squamous cell carcinoma and 30 (29%) patients had adenocarcinoma. Hospital mortality occurred in 6 (5.76%) cases because of esophageal perforation, fistula, or pyothorax, and late mortality occurred in 29 (27.9%) patients. Perforation occurred in 5 (4.8%). Improvement in dysphagia occurred after a mean of 3.3 (range 1-13) treatment sessions. Luminal patency allowing easy passing of the endoscope was achieved in 59 (93%) patients. Relief of symptoms and overall outcome improvement occurred in these patients in a relatively short time, there was body weight gain and an increase in serum albumin levels in 65% of patients.
In conclusion, control of dysphagia by laser palliation suggests that endoscopic laser therapy should not be regarded as being in competition with other treatment techniques such as surgery, radiation, chemotherapy, dilatation or stents, in contrast it plays a complementary role to these palliative modalities.
背景/目的：本研究旨在评估激光姑息治疗恶性吞咽困难的效果。
1994年11月至1997年5月期间，104例食管癌患者接受了钕钇铝石榴石激光内镜下姑息治疗。其中男性83例，女性21例，平均年龄57 ± 6.32岁。大多数病例（94%）有吞咽困难。患者每隔一周接受一次治疗，直至病情好转。
75例（72%）患者的肿瘤位于食管下三分之一处。肿瘤平均长度为6 cm（范围3 - 10 cm）。组织学检查显示，74例（71%）患者为鳞状细胞癌，30例（29%）患者为腺癌。6例（5.76%）患者因食管穿孔、瘘管或脓胸发生医院死亡，29例（27.9%）患者发生晚期死亡。5例（4.8%）发生穿孔。平均3.3次（范围1 - 13次）治疗后吞咽困难得到改善。59例（93%）患者实现了管腔通畅，内镜可轻松通过。这些患者在相对较短的时间内症状得到缓解，总体预后改善，65%的患者体重增加，血清白蛋白水平升高。
总之，激光姑息治疗吞咽困难表明，内镜激光治疗不应被视为与手术、放疗、化疗、扩张或支架等其他治疗技术竞争，相反，它对这些姑息治疗方式起到补充作用。
