食管、胃早期癌的钬激光治疗  

Endoscopic Holmium∶YAG Laser Ablation to Early Gastroesophageal Cancer

作　　者：毛永平[1] 刘庆森[1] 卢忠生[1] 范开春[1] 黄英才[1] 

机构地区：[1]解放军总医院消化科,北京市100853

出　　处：《中国激光医学杂志》2002年第2期69-72,共4页Chinese Journal of Laser Medicine & Surgery

摘　　要：目的　探讨钬激光气化切除术在食管、胃早期癌治疗中的应用价值。方法　 12例食管、胃早期癌患者 (男性 10例 ,女性 2例 ,年龄 5 2～ 81岁 ,平均 6 6 5岁 )均经胃镜病理检查证实。其中食管癌 4例 ,贲门癌 3例 ,胃底癌 1例 ,胃窦癌 3例 ,残胃癌 1例。胃镜下分型为隆起型 (Ⅰ型 ,1例 )、表浅隆起型 (Ⅱa型 ,6例 )和表浅平坦型 (Ⅱb型 ,5例 )。病理检查为高分化鳞癌、高分化腺癌和重度不典型增生局灶性癌变 (各 4例 )。内镜超声检查示病灶位于粘膜层。 9例患者因合并其他重要脏器功能障碍无法行外科手术 ,3例患者因拒绝外科手术 ,而行胃镜下钬激光气化切除治疗。术后 1～ 3个月胃镜复查 ,在原病灶部位及周围粘膜多处取组织行病理检查了解治疗效果 ,随后进行 5～ 33个月的中长期胃镜随访。结果　所有癌灶均气化切除成功。未发生任何术中及术后并发症。术后 1～ 3个月全部患者做胃镜复查 ,病理检查均未发现残存癌灶。随访 5～ 33个月 ,未发现肿瘤复发。结论　胃镜下钬激光气化切除术治疗食管。Objective To evaluate endoscopic holmium∶YAG laser ablation in the treatment of early gastroesophageal cancer. Methods Twelve patients (mean age 66 5 years old) with histologically proven early gastroesophageal 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. There were esophageal cancer (4 cases), cardia cancer (3 cases), fundus ventriculi cancer (1 case), sinuses ventriculi cancer (3 cases) and cancer of remnant stomach (1 case). Endoscopic appearances were of Ⅰ, Ⅱa and Ⅱb types. Pathological diagnosis confirmed there were well differentiated squamous cell cancer, well differentiated adenocarcinoma and high grade dysplasia associated with focal cancerization. Endoscopy was performed 1-3 months after the treatment and biopsy was made to evaluate the effects of the therapy. Long term endoscopic follow up was maintained. Results 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 5-33 months. Conclusions Endoscopic holmium∶YAG laser ablation is an effective, convenient and safe method in selected patients with early gastroesophageal cancer.

关 键 词：食管肿瘤 胃肿瘤 钬激光治疗 

分 类 号：R735[医药卫生—肿瘤] R454.2[医药卫生—临床医学]