食道・噴門部の癌性狭窄に対するレーザー治療

Abstract

Since 1982, we have performed endoscopic Nd: YAG laser therapy for palliation of cancerous stenosis of the upper gastrointestinal tract. In 111 patients suffering from malignant dysphagia, we used the Nd: YAG laser as a palliative therapy for stenosis relief and the improvement of dietary intake. The stenosis were located on the esophagus in 20 patients, on the cardia in 50 patients, and on the other in 41 patients.The “prograde method” by t he non-contact irradiation were reported by Fleischer et al, in 1982. And then, since the publication of the “retrograde method”by Ell et al, in 1986, this “retrograde method” has been routinely performed and in west counties, became the mainstream of treatment. On the other hand, our treating method were largely performed by the“prograde method”of the contact irradiation. The patients were treated once to twice a week until luminal patency was achieved, and then thereafter, were maintained by treatment given at 2-to-4-week intervals.Stenosis improvement was evaluated based on the following three definitions: Technical success, functional success, and clinical success. Luminal stenosis was graded as follows: Grade 0: A thick endoscope can pass through. Grade 1; A thin endoscope can pass through. Grade 2; 5mm at the narrowest part in width. Grade 3; A pinhole or complete obstruction. The improvement by one grade or more for one month or longer were designated as “technical success”. Dietary intake was graded as follows: Grade 0; no dysphagia, Grade 1; sometimes solids, Grade 2; semisolids, only, Grade 3; fluid only. Grade 4; complete dysphagia. The improvement by one grade or more for one month or longer was designated as“functional success”. The period of the non-hospitalization for one month or longer after the first laser therapy was designated as“clinical success”. The technical success, the functional success and the clinical success were 62.8%, 55.0% and 45.0% in esophagus, and 78.0%, 78.0% and 61.2% in cardiac region, respectively.Good adaptability to laser therapy, as to the patient's characteristics, was noted for advanced age and a performance status of grade 2 or under. Tumors located in the lower or mid third of the esophagus, those with a length of 6cm and shorter and those located cardiac region were well adapted to the Nd: YAG laser therapy. The contact method were more adaptable to each lesion than the non-contact method.As to the survival time and the lengths of time in which patients required no hospitalization (no hospitalization period), there was statistically no significance between the laser and the non-curative resection groups in cardiac region. On the other hand, the median survival time was 27 weeks in the laser group and 11 weeks in the chemotherapy alone group (P<0.05) in cardiac stenosis. In addition to that, the median value of no hospitalization period was 16 weeks in the former and only one week in the latter (P<0.05),We conclude that Nd: YAG laser therapy is a useful palliative treatment for improving the stenosis in the esophageal and the cardiac region. It could he said that the laser treatment should be applied as the first choice to a patient who is of poor risk or in whom the surgical procedure is considered to end in a no n-curative resection.