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钬激光治疗肺癌晚期大气道阻塞的可行性研究报告DOC

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中文摘要 目的 通过对钬激光在物理特性上与钕激光的对比分析,探讨钬激光在对 大气道阻塞的临床治疗的可行性。在实验中对比钕激光的治疗效果,以 明确钬激光的实用性,为中央型肺癌晚期大气道阻塞患者的带瘤姑息治 疗引入新的治疗手段,并制定其治疗标准及方案。 方法 首先在理论上以物理特性的对比,分析钬激光可以代替钕激光的能 力和原因。在动物实验中,实际操作证实钬激光在呼吸道内操作的实用 性。将实验做出的标本在显微镜下观察钬激光与钕激光切割后对组织细 胞的热损伤范围及钬激光对气管壁的损伤,并与钕激光的切割标本进行 对比。分析钬激光与钕激光在实际操作上的优缺点。并在实验中研究钬 激光的损伤范围及穿透性能,对比分析与钕激光的差异,探索钬激光在 操作中应使用的功率及使用方法,以及临床操作时需注意的安全事项。 结果 钬激光在物理特性上与钕激光的区别在于能量在组织中的散射和吸 收能力,反应在实验中,表现为损伤范围的差异。钬激光在纤支镜下操 作时,相较于钕激光更加的精确;通过分析组织的热损伤范围的区别, 推断不良反应与热损伤的关系,认为在不良反应及并发症方面,钬激光 明显优于钕激光;钬激光在对气管壁的损伤也小于钕激光。在术后气道 的再次阻塞的时间方面,钬激光与钕激光应无明显差异。 结论 根据动物实验的结果,推断出钬激光在大气道阻塞的复通治疗中有 明确的治疗效果,相比目前主流的钕激光治疗更加优秀。 1钬 激 光 可 以 引 入 临 床 对 中 央 型 肺 癌 晚 期 患 者 大 气 道 阻 塞 的 复 通 治 疗。钬激光可以更加精确、安全有效的解除患者的气道阻塞症状,改善 患者的肺功能,提高中央型肺癌晚期患者带瘤状态下的生活质量。在联 合放、化疗后,可以有效延长中央型肺癌晚期患者的生存期。 关键词,钬激光;中央型肺癌晚期;大气道阻塞;复通;姑息性治疗 2FEASIBILITY STUDY OF HOLMIUM LASER TREATMENT FOR LARGE AIRWAY OBSTRUCTION IN ADVANCED LUNG CANCER Postgraduate: Xie Chuan Specialty: Thoracic Surgery Supervisor: Prof. Wang Peng ABSTRACT Objective By analyzing the different physical characteristics of holmium laser and neodymium laser, the feasibility of clinical treatment of large airway obstruction by holmium laser treatment is researched. Comparing the therapeutic effect of holmium laser with neodymium laser in the experiment, the usability of holmium laser in clinical treatment could be ascertained. Then the new methods of tumor-bearing palliative treatment of large airway obstruction in advanced central lung cancer could be introduced. Lastly, a treatment standard and plan are made. Method First, by contrasting the different physical characteristics of holmium laser and neodymium laser, a hypothesis and the reasons are raised that neodymium laser could be substituted as holmium laser. Then, the animal experiment result confirms the operating practicality of holmium laser in the pneogaster. Putting a holmium laser cutting section under the microscope, thermal damage range of tissue cells and damage to trachea walls are observed. Similarly, a neodymium laser cutting section could be observed as well. By comparing these microscopic observations, merits and demerits of them are summarized. Finally, damage range and penetrability of holmium laser are researched. The power and usage in actual operation are explored. And the security issues in clinical operation are raised. Result The difference of holmium laser and neodymium laser in physical characteristics is the ability of scattering and absorption in the organizations. 3In the experiment, it shows up as the different damage range. Under a bronchofiberscope, operation with holmium laser is more accurate than that with neodymium laser. Checking the different thermal damage ranges made of the two kinds of lasers and researching the causality of thermal damage and adverse reaction, it is inferred that holmium laser is obviously superior to neodymium laser in adverse reactions and complications. And holmium laser makes less damage to trachea walls than neodymium laser. But, there are no significant differences in the time of trachea obstructing again after operation. Conclusion Proved by the animal experiments, holmium laser is effective in repatency of large airway obstruction, even more advanced than neodymium laser which is the most frequently-used treatment method at present. As a result, holmium laser could be used as a repatency method in clinical treatment of large airway obstruction in advanced central lung cancer. Holmium laser is more accurate, safe and effective to release the patients from symptoms of airway obstruction, improve function of their lungs, and enhance their life quality under the condition of tumor-bearing large airway obstruction in advanced central lung cancer. And combined chemotherapy and radiotherapy, the patients survive longer. Keywords: holmium laser, central advanced lung cancer, large airway obstruction, repatency, palliative treatment