RESUMO
Nineteen patients with low-grade malignant tumors of the tracheobronchial tree received Nd:YAG laser treatment. They were referred for palliation of symptomatic airway obstruction due to carcinoid (14 cases) or adenocystic carcinoma (five cases). In all patients, laser treatment was followed by symptomatic relief. Fifteen patients have done well and remain in good condition between six months and four years after laser photoresection. Two of the five patients with adenocystic carcinoma died because of hemoptysis at one and 49 months after laser therapy. In the group of 14 patients with carcinoids, two episodes of bleeding (more than 250 ml) occurred that were controlled by tamponade with the tube and coagulation by the laser beam itself. Two patients with carcinoid died of unrelated causes (stroke and gastric carcinoma).
Assuntos
Neoplasias Brônquicas/cirurgia , Tumor Carcinoide/cirurgia , Carcinoma Adenoide Cístico/cirurgia , Terapia a Laser , Neoplasias da Traqueia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Brônquicas/patologia , Tumor Carcinoide/patologia , Carcinoma Adenoide Cístico/patologia , Feminino , Humanos , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias da Traqueia/patologiaRESUMO
Overall, 400 procedures with the Yag-Nd laser were carried out in 252 patients with tracheobronchial disease susceptible to photoresection during a 4-year period. Most procedures were carried out under general anesthesia and with a rigid bronchoscope. 149 tumors were treated. Of these, 118 were malignant, 16 had low malignancy and 15 were benign. These patients received overall 203 procedures. 92 patients with 113 tracheal stenoses underwent overall 185 procedures. Finally, a miscellaneous group of 11 patients with several conditions underwent 12 procedures. Immediate results were classified as excellent, good or poor, depending on the achieved tracheal or bronchial diameter. No significant complications were found. After a 4-year experience, the authors believe that laser photoresection is currently the most effective and safe procedure to relieve obstruction in the stenoses caused by malignant proliferative tracheal or bronchial diseases not amenable to surgery. It is also the ideal substitute for surgery in benign tumors and in some cases of non-tumoral tracheal stenosis.