掺钕钇铝石榴石激光局部照射加全膀胱光动力疗法治疗膀胱癌

应用掺钕钇铝石榴石（简称Ｎｄ：ＹＡＧ）激光局部照射加全膀胱光动力疗法（ＰＤＴ）治疗膀胱移行上皮癌患者２０例，共５１个肿瘤，治愈率达９５％。疗后随诊３～２３个月，其肿瘤复发率为１０％。结果提示：Ｎｄ：ＹＡＧ激光可有效地消除膀胱的局部肿瘤，且可加强光动力疗法对局部肿瘤的作用；而全膀胱光动力疗法又可补充Ｎｄ：ＹＡＧ激光膀胱潜在病变控制的不足，有效地消除全膀胱的散在微小病灶，进而提高膀胱癌的治愈率，减少其复发率。     

激光手术治疗头颈部血管瘤

应用ＣＯ２激光气化及Ｎｄ：ＹＡＧ激光凝固方法，治疗头颈部毛细血管瘤及海绵状血管瘤３１例。治疗后随访２－４年，疗效满意。与传统治疗方法比较，具有治疗后反应轻，对周围组织损伤小，不影响功能及皮肤、粘膜外形等优点，是治疗头颈部血管瘤的首先方法。     

食管和贲门早期浅表癌内镜Nd：YAG激光治疗五年存活率和预后因素

对内镜Ｎｄ：ＹＡＧ激光治疗后癌细胞消失的３２例食管和贲门早期浅表癌病人进行了３３～７８个月（平均５５．３个月）的前瞻性随访。应用ＰｒｏｄｕｃｔＬｉｍｉｔＥｓｔｉｍａｔｅ方法计算其存活率；并与１１７例食管和贲门早期浅表癌的自然病程进行了对比分析。内镜激光治疗５年存活率为９７％，未经治疗的早期食管贲门癌５年存活率为６７％（Ｐ＜０．０１），表明内镜Ｎｄ：ＹＡＧ激光是一种有效的治疗方法。在对影响疗效因素的分析中，发现ＤＮＡ倍体数是一个有价值的独立预后因素。     

内窥镜下Nd：YAG激光切降鼻腔血管瘤

本组采用Ｎｄ：ＹＡＧ激光经鼻内窥镜切除鼻腔血管瘤３４例。术后随访６－２８个月，一次性治愈率为９４％。     

HO：YAG激光纤维支气管镜治疗气管支气管肺癌

ＨＯ：ＹＡＧ激光纤维支气管镜治疗气管支气管肺癌马伟，陈燕，柯玲上海第二医科大学仁济医院肺科，上海市激光医学研究中心（上海２００００１）有约１／３肺癌病人确诊时已属晚期，失去手术机会，其中腔内突出型肺癌病人肿瘤造成阻塞症状常无有效治疗方法。我们于１９９...     

ND：YAG激光^198Au—胶体植入法联合应用治疗肺癌

临床不能手术的晚期中心型肺癌病人，多首选化疗，往往因合并难以控制的肺不张及阻塞性肺炎，延误抗癌治疗，缩短生存期，这已成为关注急切解决的问题，在动物实验的基础上，作者对１８例晚期中心型肺癌，应用ＮＤ：ＹＡＧ激光与胶体＾１９８Ａｕ植入行瘤体内局部照射联合职，近期有效率达１００％，国同尚未见报道，与全身化疗进行疗效对比，差异显著，本文法的优点是“使晚期肺癌的治疗即可显效，迅速改善呼吸功能，控制塞性症，提     

60例次YAG激光治疗膀胱癌临床观察

我科从１９８９－１９９１年Ｎｄ－ＹＡＧ激光治疗膀胱肿瘤６０例次，随防时间４－２８个月。１例局部复发（３％），８例其它部位复发（２８％）。３４例病人均未见穿孔、大出血合并症。激光治疗安全，适用于有选择性的膀胱肿瘤病人。     

HO∶YAG激光纤维支气管镜治疗气管支气管肺癌

ＨＯ∶ＹＡＧ激光纤维支气管镜治疗气管支气管肺癌马伟陈燕柯玲上海第二医科大学仁济医院肺科上海市激光医学研究中心（上海２００００１）有约１／３肺癌病人确诊时已属晚期，失去手术机会，其中腔内突出型肺癌病人肿瘤造成阻塞症状常无有效治疗方法。我们于１９９５年４...     

YAG激光治疗膀胱肿瘤体会

山东省烟台山医院自 1996年以来 ,应用ＹＡＧ激光治疗 19例膀胱肿瘤患者 ,取得了满意疗效 ,总结如下。1　临床资料1.1　一般资料本组 19例患者中 ,男 14例 ,女 5例 ;年龄 38～ 6 6岁。其中6例为复发性膀胱肿瘤。 17例在激光治疗前取活检确诊为膀胱移行上皮癌。 2例曾用其他治疗方法 ,如膀胱部分切除术等 ,因复发肿瘤小于 0 .5ｃｍ ,未取活检 ,直接用激光照射。本组病例中 ,肿瘤直径 0 3～ 3ｃｍ ,平均 1 5ｃｍ。1.2　治疗方法ＹＡＧ激光波长 10 6 4ｎｍ ,输出功率 5 0～ 70Ｗ。男性患者在尿道粘膜表面麻醉下进行 ,女性患者不用麻醉。膀胱充…     

食管癌放疗后狭窄的内镜激光治疗

食管癌放疗后狭窄,无论是手术后放疗的吻合口狭窄,还是根治性放疗后的狭窄,都是放疗科医生、甚止外科医生很难解决的问题。传统的狭窄扩张术和气囊导管扩张术难以解决根本问题。我们自１９９１年４月采用Ｎｄ：ＹＡＧ激光通过内镜进行治疗食管放疗后狭窄２５１例,共５...     

Evaluation of the efficacy of photodynamic therapy on experimental hepatocellular carcinoma--using local injection of photosensitizer

The effect on photodynamic therapy (PDT) of using pheophorbide-a as a photosensitizer and Nd: YAG laser (Q-switch) was evaluated. Two hundred micrograms (0.1 ml) of pheophorbide-a was injected into tumors that had been subcutaneously implanted into the backs of nude mice (BALB/c-nu). Interstitial Nd: YAG laser irradiation (Q-switch; mean power 0.5 W, duration 10 min.) was performed 72 hours after pheophorbide-a injection. Forty-eight hours after laser irradiation, the areas of tumor necrosis were measured; these were larger in the group with the injection of pheophorbide-a than in those without. The areas of tumor necrosis after Nd: YAG laser irradiation at a higher mean power (Q-switch; mean power 2 W, control temperature 43-43.5 degrees C, duration 10 min.) were also measured. Again, the areas were larger in the group injected with pheophorbide-a. These results show that the injection of pheophorbide-a and interstitial irradiation using Nd: YAG laser induce a photodynamic reaction, and that this combination is useful in the treatment of deep-seated tumors.     

Resection of fixed pelvic tumors using the Nd:YAG laser

Clinical experience using the Nd:YAG laser to resect intra-abdominal malignancies is limited. Presented are two cases of recurrent gynecologic cancers, one ovarian carcinoma of low malignant potential and one fallopian tube carcinoma grade 1, in which the Nd:YAG laser allowed removal of recurrent tumor fixed to sacral bone and pelvic sidewall. The ability to accomplish laser vaporization of the tumor bed along with periosteum may reduce the risk of local recurrence. Further investigation of laser treatment of tumors fixed to sacral or pubic bone, pelvic sidewall tissues or other structures should lead to the evolution of the Nd:YAG laser as a useful tool to the cancer surgeon.     

Laser treatment of urologic cancers

In urologic surgery, laser energy has been used to treat various cancers of the genitourinary system. Excellent functional and cosmetic results have been obtained with squamous cell carcinoma of the penis. In selected patients, the need for partial penectomy may be avoided. Demonstrated practical advantages and decreased patient morbidity form the basis for laser treatment of superficial bladder cancer. Therapeutic advantages over electrocautery resection are theoretical. Nd:YAG laser treatment can provide reasonable local control rates for tumors that invade the bladder muscle, but this treatment should be reserved for patients who are poor candidates for radical surgery. For kidney cancer, lasers may facilitate tumor removal in solitary kidneys and extend the margin of resection.     

Neodymium yttrium‐aluminium‐garnet laser resection significantly improves quality of life in patients with malignant central airway obstruction due to lung cancer

Neodymium yttrium‐aluminium‐garnet (Nd : YAG) laser resection is one of the mostly used interventional pulmonology techniques for urgent desobstruction of malignant central airway obstruction (CAO). The major aim of this trial was to evaluate potential influence of Nd : YAG laser resection on overall quality of life (QoL) in patients with central lung cancer. Patients with malignant CAO scheduled for Nd : YAG laser resection were prospectively recruited in the trial. All patients were given European Organization for Research and Treatment, Quality of Life questionnaire (EORTC QLQ‐30 v.3) before the procedure and approximately 2 weeks after the treatment. There were 37 male and 10 female patients, average age 54 ± 10 years. Most common tumour type was adenocarcinoma diagnosed in 51% of patients. Majority of patients were diagnosed in stage IIIB (53.2%) and stage IV (25.5%). Most common Eastern Cooperative Oncology Group performance status was 1 (72.3%). Nd : YAG laser resection significantly improved (P < 0.0001) QoL and overall health according to EORTC QLQ‐30. However, in some of the questions dealing with nausea, vomiting, diarrhoea, constipation, family life, social activities and financial situation, we did not observe statistically significant improvement. Nd : YAG laser resection of malignant CAO significantly improves QoL and overall health in patients with lung cancer.     

Review: Lasers: Reflections on their evolution

A review of the past 22 years of laser applications shows that a great deal of progress has been made. It allows one to see the evolution of laser therapy, compare it with other modalities used in surgical oncology, and identify certain program that merit clinical trial. Use of lasers in surgical oncology began with a laser knife. Tissues were divided and removed with the focused beam of the CO₂ laser, which replaced the scalpel previously used to perform surgical procedures. Later, the Nd:YAG laser was used in hollow visci such as the trachea and esophagus to open obstructed passages and possibly to cure many cancers. The operating microscope was used in the larynx to remove benign and malignant lesions, and for obstructing lesions to provide time to treat medical complications by reopening airway passages, and to add irradiation and/or chemotherapy preoperatively. Many times the Nd:YAG laser was used gastroscopically to treat bleeding or obstruction. Cytoreduction by laser made surgery or chemotherapy, or both, plausible. Addition of the sapphire tip and, later, the bare or sculptured fiber increased the variety of procedures possible with the Nd:YAG laser. Photodynamic therapy (PDT) uses various drugs that are localized in cancer cells. The cancer is then destroyed by laser emissions of the proper wavelength. One of the problems with PDT is getting the light to the tumor. Preactivation is addressed in this report. The problems associated with anaerobic tumors are discussed and suggestions for clinical trials offered. Laser hyperthermia is compared with induced hyperthermia as well as in combination with irradiation. Protocols of local laser hyperthermia combined with irradiation need further exploration. This review addresses the use of lasers in the destruction of tumor cells for bone marrow transplant and several old and new experiments used to block the AIDS virus. Finally, ongoing research is discussed, including the present and future roles of lasers. J. Surg. Oncol. 64:84–92 © 1997 Wiley-Liss, Inc.     

Current role of laser and photodynamic therapy in gastrointestinal tumors and analysis of a 10-year experience.

Laser energy can be used for a variety of neoplastic diseases including benign tumors, early stage malignancies, and advanced carcinomas, either with curative intent or for palliation. Nd:YAG laser photocoagulation of 168 colorectal adenomas allowed a complete eradication in 70% of cases, after a mean follow-up of 22 months. Advanced and obstructing tumors were treated with Nd:YAG laser to recanalize the lumen. In the upper gastrointestinal tract the recanalization of the lumen by means of laser photocoagulation improved the quality of life and survival. In fact, in our series of 308 patients treated, 1-year survival was 23% in recanalized patients and 7% in nonrecanalized patients. In the lower gastrointestinal tract, 289 cancer patients were treated and an amelioration of symptoms related to the obstruction was obtained in 93%. The current indication for photodynamic therapy is mainly the treatment of flat or ulcerative early stage tumors in the esophagus and stomach of high risk patients. Out of 17 patients treated, 14 were locally cured.     

Radical breast surgery with a contact Nd:YAG laser scalpel.

The use of a contact Nd:YAG laser scalpel during radical and modified radical mastectomy was evaluated in 18 patients with carcinoma of the breast. The laser scalpel performed well as a haemostatic tool, the associated mean blood loss for modified radical mastectomy being 132 ml. Operating time, operative blood loss, laser energy required and postoperative wound drainage were all related to patient obesity, correlating significantly with body weight and/or breast weight. The incidence of axillary seroma was not reduced by laser surgery and occurred in 53% of patients undergoing modified radical mastectomy. The Nd:YAG laser scalpel is an excellent haemostatic tool but it does not appear to have any other advantages over conventional surgery for mastectomy.     

Long-term follow-up results of Nd: YAG laser treatment of premalignant and malignant (Stage I) squamous cell carcinoma of the oral cavity

BACKGROUND AND OBJECTIVES: Only few studies (none from India) have reported the role of Neodymium Yttrium-Aluminum-Garnet (Nd: YAG) laser for treatment of premalignant and stage I (T1N0M0) oral cancer. This study aimed to assess the outcome of Nd: YAG laser in the said lesions after a follow-up of 5 years. Design: Prospective study; Setting: a tertiary care hospital, North India. PATIENTS AND METHODS: Fifty biopsy proven patients of premalignant/malignant (Stage I) lesions oral cavity underwent Nd: YAG laser treatment after prior informed consent from January, 1997 to January, 2000. Patients were followed-up for 5 years. In addition to local recurrence, patient's mucosal response to laser in terms of pain, mastication, salivation, paraesthesias, facial expressions, and speech was also recorded. RESULTS: Twenty-seven patients had leukoplakia, 3 erythroplakia, 6 carcinoma in situ (CIS), and 14 stage I squamous cell carcinoma (SCC) of oral cavity. Four patients required repeat laserization for residual/ recurrent lesion and 15 patients were lost to follow-up. Recurrence free survival (RFS) at 5-years in premalignant and stage I SCC patients was 97.2 and 78.6%, respectively. A minimal persistent edema was observed in 6 (12%) patients at the end of 7th day, rest all tolerated the procedure well. CONCLUSIONS: The present study indicates that Nd: YAG laser is an effective and safe surgical option management of premalignant and malignant lesions of oral cavity.     

内窥镜,Nd：YAG激光对食管癌,贲门癌梗阻的姑息治疗

1988年12月至1989年12月,我们对19例晚期食管癌、贲门癌梗阻或严重狭窄的患者,在内窥镜直视下行Nd:YAG激光治疗。其中食管癌10例,贲门癌9例;鳞状细胞癌10例,腺癌9例。治疗前,7例肿瘤已将管腔梗阻。治疗功率30～50W;每次治疗剂量900～2500J,中位治疗剂量为1500J/次;平均每例治疗3次(范围1～7次);治疗总剂量1500～7250J,中位治疗总剂量4000J。治疗后,患者均能顺利进食半流质食物,缓解期1～7月,中位缓解期为3个月。     

Tissue effects of neodymium:YAG laser photoradiation of canine ureters

Although the entire ureter and renal collecting system are accessible for endoscopic treatment with a neodymium:YAG, (Nd:YAG) laser, specifications for safe laser application within the ureter are not established. After various doses of Nd:YAG laser energy were delivered, the midureters of six mongrel dogs were studied to determine tissue effects. Doses which are appropriate within the bladder (35 watts X 2 seconds) resulted in perforation and urine leak from the ureters. Higher doses (60-65 watts) of short duration were tolerated without problems and nonstrictured healing ensued. Further studies are necessary before Nd:YAG laser treatment of mid-ureteral tumors is recommended.