Lobe-sparing resection of multiple pulmonary metastases with a new 1318-nm Nd:YAG laser--first 100 patients.
Rolle A,et alAnn Thorac Surg2002 Sep
1Department of Thoracic and Vascular Surgery, Fachkrankenhaus Coswig (Centrefor Pneumology and Thoracic Surgery), Coswig/Dresden, Germany.
BACKGROUND已经开发出一种新的1318nm Nd：YAG激光器，其利用第二波长（1318nm; 40瓦）来更精确地切割，凝固和密封肺结节附近的肺组织。这种激光允许精确的实质内结节切除术，5毫米的组织破坏边缘和随后的肺实质重新接近，以避免肺叶扭曲。这种激光技术有助于切除肺部的多发，双侧和复发性肿瘤。
METHODS在连续100例患者（53名男性，平均年龄60岁; 47名女性，平均年龄61岁）中进行各种原发（最常见的是肾脏和结直肠），通过前外侧开胸手术进行了155次激光切除术（如果是双侧的话，分期为3至4周）使用新的1318-nm Nd：YAG激光器。如果判断肿瘤或残肺比例有利，则用2至3mm可见肿瘤边缘（加上激光能量扩散继发的5mm残余肺坏死边缘）除去所有可触及和可见肿块。没有使用钉合装置或生物粘合剂。
BACKGROUNDA new 1318-nm Nd:YAG laser has been developed to utilize the second wavelength (1318 nm; 40 watt) to more precisely cut, coagulate, and seal lung tissue adjacent to pulmonary nodules. This laser allows a precise intraparenchymal nodulectomy with a 5-mm rim of tissue destruction and subsequent lung parenchymal reapproximation to avoid lobar distortion. Resection of multiple, bilateral, and recurrent tumors in the lung is facilitated by this laser technique.
METHODSIn 100 consecutive patients (53 men, mean age 60 years; 47 women, mean age 61 years) with various primaries (most commonly renal and colorectal), 155 laser resections were performed via anterolateral thoracotomy (staged 3 to 4 weeks, if bilateral) using a new 1318-nm Nd:YAG laser. All palpable and visible masses were removed with 2 to 3-mm visible tumor margins (plus a 5-mm rim of residual lung necrosis secondary to laser energy dispersal) if the tumor or residual lung ratio was judged favorable. No stapling devices or bioadhesives were used.
RESULTSSix hundred thirty-two metastases (6.3 per patient, range 1 to 124) were resected. Despite 41% centrally located metastases, tumor resections were possible in 95% of patients with only a 5% lobectomy rate. Of the 100 patients, 67 were considered "curative" with complete metastasectomy by inspection and palpation, and 23 were judged incomplete from too extensive tumor or residual lung, miliary lung spread, or pleural studding. There were no associated mortalities and two complications, including bleeding (1) and a prolonged airleak (1), both treated conservatively. Follow-up was complete in all patients for a median of 26.5 months with clinic visits and chest computed tomographic scan every 3 to 6 months. Nine recurrences were detected and underwent reoperation. Overall survival in the completely resected "curative" group was 85% at 1 year, 71% at 2 years, 69% at 3 years, 57% at 4 years, and 32% at 5 years; in the completely resected "palliative" group, they were 70% at 1 year, 36% at 2 years, 12% at 3 years, and 0 at 4 years; in the incomplete group, they were 56% at 1 year, 30% at 2 years, and 0 at 3 years.