気管食道科領域におけるレーザーの応用

Abstract

Laser applications for tracheo-broncho-esophageal lesions are reviewed from the aspects of diagnosis and treatment. As for diagnosis, tumor localization by fluorescence photostimulation using a tumor-specific photosensitive substance and laser irradiation, and three dimentional analysis with fiber grating are discussed. As for treatment, the photoradiation therapy with hematoporphyrin derivative and argon dye laser is presented. Regarding the treatment utilizing heat effect with CO2 and Nd-YAG laser, indication for cicatrical or carcinomatous stenosis of the lower respiratory tract is discussed based on the author's experience. As for the indication of endoscopic laser surgery for cicatricial stenosis, the following points are stressed.1) Partial stenosis is well controlled by laser vaporization alone without insertion of a silicone tube.2) Insertion of a silicone tube following laser vaporization is a reliable procedure for a circular or segmental stenosis.3) As for a stenosis just below the vocal fold, the open technique would be employed because of the difficulty of aduquate fixation of a tube.4) In those cases whose tracheal framework is damaged, the above methods are not suitable but a conventional operation is preferable.The effect of endoscopic laser surgery for the treatment of carcinomatous lesions is limited, and the technique is mainly used as palliative procedure to preserve the airway.However, possibility still remains for its application as a part of the multidisciplinary treatment consisting of preoperative procedures for improving general status, chemotherapy and/or radiation