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Traitement endoscopique au laser des tumeurs colo-rectales

Endoscopic laser-therapy of colorectal tumours

  • Published:
Acta Endoscopica

Résumé

Notre expérience du traitement endoscopique au laser (TEL) concerne l’emploi des lasers Nd:YAG ou Argon ainsi que le traitement endoscopique photodynamique (TEP) par laser Argon avec colorants.

De juin 1981 à avril 1987, 235 patients ont subi un total de 1 183 séances de traitement par laser Nd:YAG et Argon pour tumeurs bénignes ou malignes et lésions vasculaires du tractus digestif inférieur. Le TEL a été pratiqué à titre palliatif pour tumeurs colorectales avancées à la suite d’un saignement (18 cas) ou d’une obstruction (79 cas) ; l’hémorragie a été arrêtée dans tous les cas et les symptômes liés à l’occlusion ont été levés chez 90 % des patients.

Le traitement au laser Nd:YAG a été utilisé à titre curatif chez des malades à haut risque chirurgical ou dans des cas bien sélectionnés, et les lésions concernées sont des adénomes simples ou multiples (125 patients). La disparition endoscopique et histologique des adénomes, pendant une période d’au moins 3 mois a été obtenue dans 100 % des lésions inférieures à 1 cm, 75 % des lésions de 1 à 4 cm, 42 % des adénomes de diamètre supérieur à 4 cm. Des lésions en hémorragie active ou potentielle, telles que des angiomes ou des angiodysplasies (13 patients) ont également été traitées par laser ; une hémostase définitive a été obtenue dans 71 % des cas.

Le laser Argon avec colorant après photosensibilisation (HpD) a permis un traitement endoscopique TEP dans 7 cas de carcinome colorectal évolué (traités entre juillet 1982 et avril 1987) : une réponse complète et 6 réponses partielles ont été obtenues.

Summary

Our experience concerns endoscopic laser-therapy (ELT) using Nd:YAG and Argon lasers as well as endoscopie photodynamic therapy (PDT) with an Argon-Dye laser system.

Out of 2025 laser treatments two hundred and thirty-five patients underwent a total of 1183 Nd.YAG or Argon laser treatments for malignant or benign tumors, and vascular lesions of the lower gastro-intestinal tract, from June 1981 to April 1987. ELT of colorectal advanced tumors was performed for palliation of bleeding (18 patients) and obstruction (79 patients) ; bleeding was stopped in all cases and a control of symptoms related to the obstruction was obtained in 90 % of cases. Tumors in the initial stages were treated by Nd.YAG laser for curative purposes in high surgical risk patients or in carefully selected cases, like adenomas and adenomatosis (125 patients). The endoscopie and histological disappearance of the adenomas, for a period of at least 3 months, was obtained in 100 % of lesions smaller than 1 cm, 75 % of the 1-4 cm lesions and 42 % of adenomas larger than 4 cm. Also lesions actively or potentially bleeding, like angiomas and angiodysplasias (13 patients) were treated ; a definitive haemostasis was achieved in 71 % of the cases. The Argon-Dye laser in combination with a photosensitizer (HpD) made possible the endoscopie PDT of advanced colorectal carcinoma in 7 patients (from July 1982 to April 1987) : one complete and 6 partial responses were obtained.

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  1. P. Spinelli

    Present address: Istituto Nazionale per lo Studio e la cura dei Tumori, Via E. Venezian 1, 20133, Milano, Italy

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  1. Istituto Nazionale per lo Studio e la cura dei Tumori, Via E. Venezian 1, 20133, Milano, Italy

    M. Dal Fante & E. Meroni

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  2. M. Dal Fante
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Spinelli, P., Dal Fante, M. & Meroni, E. Traitement endoscopique au laser des tumeurs colo-rectales. Acta Endosc 17, 157–168 (1987). https://doi.org/10.1007/BF02968601

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