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支气管镜激光在成人气道疾病治疗中的应用

Author
Henri G Colt, MD
Section Editor
Praveen N Mathur, MB;BS
Deputy Editor
Geraldine Finlay, MD

引言

支气管镜激光治疗是一种使用热消融技术的治疗方式。支气管镜激光可切割组织和凝血，这使它成为一种处理气道疾病有关症状的有用工具。本文将总结此疗法的适应证、效果、禁忌证、设备和技术。其他用于处理气道梗阻的支气管镜技术将单独讨论。 (参见“中央气道阻塞的诊断与处理”和“支气管内电烙术”和“肺癌的光动力治疗”和“支气管镜下氩气刀在成人气道疾病处理中的应用”和“气道支架”和“可屈性支气管镜下气囊扩张”和“支气管内近距离治疗”和“成人支气管镜冷冻技术”)

适应证和效果

通常，支气管镜激光治疗是一种速效、姑息性或辅助性的治疗方式，用于减轻由恶性或良性病变引起的中央气道梗阻(central airway obstruction, CAO，气管和主支气管)[1-3]。理想的病灶是管腔内较短的病灶，即短于4cm，这样梗阻远端的区域仍然可见，并且远端肺组织具有功能。此疗法并不适合于由气道外压迫导致的CAO或者远端病变，即主支气管以远的病变。气管或主支气管中延伸较长的病变通常不适合使用激光治疗，但在机械性减瘤前可使用激光对肿瘤组织进行光凝和去血管化。在较少见情况下，激光可用于治疗咯血，极少数情况下也可用于治疗局限于气道且不可手术的放射影像学隐匿性肺癌(radiographic occult lung cancer, ROLC)。

治疗中央气道梗阻的方法和方式选择，以及局部消融支气管镜技术的对比将单独讨论(表 1和表 2)。 (参见“中央气道阻塞的诊断与处理”)

恶性中央气道梗阻

患者或肿瘤的特征 — 由支气管肺癌导致的CAO是激光切除的最常见适应证(表 3)[4-10]。通常，激光治疗是一种姑息性治疗，用于其他一线疗法(如，手术或放射治疗)不可行的患者和/或需要立即缓解严重危及生命的梗阻的患者。偶尔，在补救性化疗、放疗(如，外照射或近距离治疗)或手术切除之前，它可作为辅助治疗。适合激光切除的理想病灶是长度较短的肿瘤，即短于4cm，并且有明显的管腔内部分，伴或不伴出血。激光治疗的效果通常并不持久，因此需要联合其他支气管镜治疗(如，电烙术、冷冻疗法、置入支架、扩张和近距离治疗)或重复治疗(通常是出于姑息性治疗目的)。 (参见“支气管内电烙术”和“气道支架”和“可屈性支气管镜下气囊扩张”和“支气管内近距离治疗”和“中央气道阻塞的诊断与处理”和“成人支气管镜冷冻技术”)

非小细胞肺癌(non-small cell lung cancer, NSCLC)，特别是鳞状细胞癌，是最常见的适于激光切除的恶性肿瘤。然而，也有其他类型恶性肿瘤得到成功治疗的病例报告，这些肿瘤包括：类癌，囊性癌，黏液表皮样癌，以及由黑素瘤、结肠癌、肾癌和乳腺癌引起的支气管内转移癌[11-13]

                       

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Literature review current through: 2017-07 . | This topic last updated: 2016-02-04.
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