钬激光治疗消化道早期癌的远期疗效

Long Term Effect of Endoscopic Ho:YAG Laser Ablation of Early Gastrointestinal Cancer

目的评价内镜下钬激光治疗消化道早期癌的远期疗效。方法消化道早期癌患者20例,男性14例,女性6例;年龄46～81岁,平均67岁。内镜检查:食管癌7例,贲门癌3例,胃底癌1例,胃窦癌4例,残胃癌1例,乙状结肠癌1例,直肠癌3例。组织病理学检查:高分化鳞癌4例、管状腺癌1例、高分化腺癌8例、重度不典型增生局灶性癌变4例。内镜超声检查示早期癌病灶均局限于黏膜层,均无黏膜下层侵润。内镜下分型为隆起型(Ⅰ型)1例,表浅隆起型(Ⅱa型)12例、表浅平坦型(Ⅱb型)7例。20例早期癌患者中,16例因合并其他重要脏器功能障碍而无法外科手术,3例因不愿意接受外科手术而行内镜下钬激光治疗,1例因行内镜黏膜切除术失败而行内镜下钬激光治疗。经内镜活检管道插入直径400μm的光导纤维,以功率15 W、脉冲能量1.0 J,波长2.1μm的钬激光气化切除病灶。激光照射范围超出病灶0.5 cm。结果所有患者病灶均气化切除,术中及术后未发生消化道出血、穿孔及狭窄等并发症,随访36—72个月内镜检查均未发现肿瘤复发。结论内镜下钬激光治疗消化道早期癌的远期疗效良好。

Objective To evaluate the long term effect of endoscopic holmium ： YAG laser ablation in the treatment of early gastrointestinal cancer. Methods From September 1996 to September 2006, the patients with histologically proven gastrointestinal cancer, who had severe underlying diseases such as heart disease, respiratory disease, liver disease, or refused to receive operation, were treated with endoscopic ablation using holmium： YAG laser. All patients fulfilled the following criteria： 1 ） diagnosed as having mucosal gastrointestinal carcinoma by endoscopic findings and EUS, 2 ） had a biopsy specimen obtained from the lesion that revealed differentiated carcinoma, 3 ） did not have an ulceration in the lesion, 4） had a tumor up to 25 mm in diameter. Endoscopy was performed 1-3 months after the treatment and biopsy was made to evaluate the effects of the therapy. Long time endoscopic follow-up was maintained. Results A total of 20 patients with early gastrointestinal cancer were treated with endoscopic ablation using holmium： YAG laser. All nidi of the patients were detected by endoscopic ultrasonography （EUS） and were confirmed in the mucosal layer, including 7 cases of esophageal cancer, 3 cases of cardia cancer, 1 fundus ventriculi cancer, 4 sinuses ventriculi cancer, 1 cancer of remnant stomach, 1 sigmoid colon cancer, and 3 cases of rectal cancer. Endoscopic appearances were of Ⅰ , Ⅱ a and Ⅱ b types. Pathological diagnosis was well differentiated such as squamous cell cancer, well differentiated adenocarcinoma and high grade dysplasia associated with focal canceration, respectively. Complete eradication of the nidi was achieved in all the patients without any operative or delayed complications. At endoscopy, there was no residual cancer. No recurrence was found during a follow-up of 3-6 years. Conclusions Endoscopic holmium ： YAG laser ablation of early gastroesointestinal cancer is an effective, convenient and safe method in selected patients.