癌性食道通過障害に対する内視鏡的Nd: YAGレーザー治療: 適応とその限界

抄録

Seventy patients who underwent endoscopic Nd: YAG laser therapy for palliation of esophageal and cardiac cancer were evaluated in detail to define clinical characteristics suitable for laser therapy. In the 70 patients, 20 were esophageal cancer and 50 were cardiac cancer.
In cardiac cancer, 78.0%(39/50) showed the technical success, 78.0%(39/50) showed the functional success, and 59.2%(29/49) showed the complete functional success (discharge period of more than one month from the hospital). In esophageal cancer, on the other hand, the rates of the technical success, the functional success and the complete functional success were 55.0%(11/22),, 55.0%(11/22) and 40.0%(8/20), respectively.
The contact method was more effective than noncontact method, and the mean number of treatments required to alleviate symptoms and remove obstruction was 4.6 (range: 1-16). As to the patient's characteristics, good adaptability to laser therapy was noted for advanced age (more than 75 years), a performance status of grade 2 and under, and well differentiated adenocarcinomas (pap, tub1). Esophagial cancer with a length of 5 cm and under were well adapted to laser therapy. Limit or inadaptability to laser therapy was noted for a performance status of grade 3 and over, and an appearance of peritonitis cartinomatosa. Esophageal tumors located in the cervical region, those with a length of 8 cm and over, those with pulmonary metastasis, and those of re-stenosis after radio-therapy were limits to laser therapy.