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Endoscopc Nd:YAG laser treatment for tracheobronchial malignancies with unresectable advanced diseases Takehiko Fujisawa, Yutaka Yamaguchi, Masayuki Baba, Mitsutoshi Shiba, Toshikazu Yusa, Hisami Yamakawa, Yukio Saitoh and Toshio Fukasawa Department of Surgery, Institute of Pulmonary Cancer Research, School of Medicine, Chiba University The objectives of this study are to demonstrate 1) the effect of endosco— pic Nd:YAG laser irradiation on air way dilatation and/or hemostasis, 2) the prolongation of life span and 3) the possibility predicting necessary joules for tumor vaporized volume.The materials consisted of a total of 84 malignant tumors including 56 tracheobronchial carcinomas, 18 esophageal carcinomas and 10 other malignancies.The results obtained herein are as follows; 1)The improvements were demonstrated in 72(86%) of 84 patients and the higher improvement per centage was shown in the more central site. The type of diseases, however, had no particular relation to the effect. 2)Avroximately 20 joules were necessary for 1 mm3 vaporization of tumor. 3)Median survival periods in improved and unchanged patients were 6 months and 3 months, respectively. Furthermore, 5 year survival rate in improved pa— tients were 11% which is fairly good, in contrast, no one survived beyond 1 year in unchanged patients. The results between these 2 groups were statistically significanitly different. In conclusion, endoscopic Nd:YAG laser treatment is considered to be very effective on the air way dilatation resulting in relief of dyspnea and the prolongation of I ife span. Appropriate joules for necessary tumor vaporization could be predicted and the treatment not irradiating excessive joules is appeared to be inevitable in the decrease of its fatal complications. I.緒 言 気管気管支に浸潤増殖 し中枢気道を狭窄する 悪性腫瘍は喘鳴、呼吸困難等の強い呼吸器症状 を呈し、気道開大が第1選 択となるが、内視鏡 的YAGレ ーザー治療は救命救急的手段として極 めて有用であることを報告 した1)2)。 しかしそ の際出血や煙の吸引等による合併症も少ないな がら経験 した3)。 本研究においては現在までの気管気管支の切 除不能進行悪性腫瘍に対する内視鏡的YAGレ ー ザー治療成績を総括すると共に、本治療法の安 全性をさらに確立することを目的にレー ザー照 射量と気道内腫瘍昇華との関連を組織別に検討 し、至適照射量の予測の可能性にっき考察した。