THERMAL EFFECTS OF Nd YAG LASER AND INDICATIONS IN BRONCHIAL TREE PATHOLOGY

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THERMAL EFFECTS OF Nd YAG LASER AND INDICATIONS IN BRONCHIAL TREE PATHOLOGY

Y. Martinat, J. Guerin

To cite this version:

Y. Martinat, J. Guerin. THERMAL EFFECTS OF Nd YAG LASER AND INDICATIONS IN

BRONCHIAL TREE PATHOLOGY. Journal de Physique Colloques, 1987, 48 (C7), pp.C7-213-C7-

216. �10.1051/jphyscol:1987746�. �jpa-00227050�

THERMAL EFFECTS OF Nd YAG LASER AND INDICATIONS IN BRONCHIAL TREE PATHOLOGY

Y. MARTINAT and J.C. GUERIN

Hepita1 de la Croix-Rousse, Service de Pneumologie, F-69004 Lyon, France

INTRODUCTION

I

-

LUNG CANCER TREATMENT 1) THORACOTOMY 2) IRRADIATION 3) CHEMOTHERAPY

I1

-

TRACHEAL STENOSIS TREATMENT

-

surgery - diathermy

-

tracheotomy

-

intubation Symptomatic treatment :

,

YAG LASER IN TRACHEO-BRONCHIAL TREE PATHOLOGY

-

290 patients

-

malignant tumors : 174 (60 %) tracheal st6nosis : 78 (27 %)

-

others indications : 38 (13 %)

-

0 2

-

Analgesic - YAG laser

I

-

MATERIAL AND METHODS

lo) Trach6o-bronchial malignant tumors

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174 cases (60 %)

-

Bge : 28

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86 (x : 64)

-

male : 92 %

Article published online by EDP Sciences and available at http://dx.doi.org/10.1051/jphyscol:1987746

JOURNAL DE PHYSIQUE

-

patho-anatomy :

macroscopy :

-

exuberant granulations : 71 %

I

^{- in£} iltrant lesions : 5 %

I ^-

infiltrant and exuberant

lesions : 24 %

microscopy :

-

primitive tumor

I ^-

metastatic tumor ^: : ⁸⁵ 15 ^% %

-

localisazion : simple point : 70 % multiple points : 30 %

-

previous treatment : none : 70 % one or several : 30 %

-

ideal indications :

-

clinical : adulte dyspnea radiological : atelectasis

endoscopic : exuberant granulations

2O) Tracheal stenosis

-

78 cases (27 %)

-

Lge : 4

-

79

(I

: 44)

-

male : 60 %

-

patho-anatomy

-

true stenosis (after intubation

-

tracheotomy or surgery) 75 %

- tracheal granuloma (after tracheotomy or surgery) 25 %

3O) other indications

-

^{38 cases}

-

^{Lge : 18}

-

75

(x'

: 52)

-

male : 55 %

-

patho-anatomy :

-

tumor locally malignant - benin tumor

- endobronchial suture

-

foreign body - angiona

-

dysplasia

-

wegener disease

-

clinical (dyspnea)

-

radiological

-

endoscopic

-

evolution

lo) Results : malignant tumors

-

clinical : amelioration 70 %

-

radiological : amelioration 40 %

-

endoscopic : excellent 44 % ( complete disparition)

good 36 %

(> 50 %)

failure 20 %

-

evolution : mean survival : 130 days

-==+

symptomatic treatment

2 O ) results : tracheal stenosis

-

clinical : amelioration 100 %

-

endoscopic :

-

excellent : granuloma

I

true stenosis : ^: 63 ¹⁰⁰ % ^%

-

good t r u e stenosis : 37 %

-

evolution : excellent ^I (no relapse ) granuloma : 100 %

I

true stenosis : 25 % 3O) results : other indications

TUMOR LOCALLY MALIGNANT

.

immediate results : excellent 70 %

.

long term results : excellent 50 %

OTHERS

.

benign tumor excellent (819)

-

endobronchial suture (313)

.

foreign body ¹¹ (112)

.

angioma I t (112)

.

^{dysplasia I1} (012)

.

Wegener disease I I (1)/2)

111

-

COMPLICATIONS

INCIDENT

.

neurological : 2 epileptic seizures

I

² regressive hemiplegia

JOURNAL DE PHYSIQUE

.

cardiovascular : 1 vagal syncope

.

haemorrhage : 4

accident d e a t h : 2 - 1 h a e r n o r r h a g e

1-

1 pneurnothorax on copd

.

broncho-pleural fistula : 1

.

acute respiratory insufficiency : 2

IV - DISCUSSION

Technique

-

local or general anesthesia ? It depends on :

-

lesion tomography

.

patient tolerance

.

patient status

.

practitioner experience indications and results

malignant tumors :

.

symptomatic treat ment

.

best resultats with exuberant lesions tracheal stenosis :

.

good treatment for granuloma

.

for true stenosis, laser YAG if surgery is contra-indicated tumor locally malignant : YAG laser only where surgery is contra-indicated or for

relapses after surgery

ochers indications : rare but good results for benign tumors

CONCLUSION

-

interesting technique for bronchial t r e e pathologies - most often symptomatic treatment

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improves patient comfort

-

complements previous or future treatments