engleski

Laser therapy with ND:YAG and diode laser in endoluminal obstructing processes of proxymal airways-comparsion and advantages

Advances in technology during last four decades, since first appliance of laser in tracheobronchial pathology, made laser devices more effective, simpler and more accurate in dosing of laser with less complications. Our aim was to compare efficacy and complication rates of Nd:YAG and modern diode laser, which we used recent two years. Diode laser therapy was performed in 106 patients predominatly with inoperable non-small cell carcinoma (67%). Processes were located mainly in proximal airways (trachea-subsegmental bronchi). Other patients suffered from benign tumors, granulations and cicatrial processes in trachea and large bronchi (27%), occasionally venectasiases and leucoplakias (6%). Similar distribution of pathological processes was found in group of 78 patients treated with Nd:YAG laser: malignant inoperabile processes (70%), benign tumors and granulations (24%), venectasiases and leucoplakias (6%). Diode laser beam was delivered via light guide quartz fiber 0, 4 mm in diameter, inserted through the "Olympus" T 40 flexible fiberbronchoscope`s working channel, mostly in local anesthesia. This type-"One laser" (wavelength 810 nm) wasused with 15-30 W power (max. 60W) and 1-2 seconds pulse duration. Nd:YAG laser was used with 15-60 W power (max. 100 W) and 0, 5-2 s pulse duration. Effect of laser therapy was evaluated clinically, by immediate and follow-up bronchoscopy, respiratory function tests, chest X-ray, CT and rarely by MRI and RLS. Our results showed equal efficiency of both laser devices in recanalisation of obstructed airways, achieved in 81% patients. Results are similar to our results reported during recent years. Diode laser showed lower complications rate in comparsion to Nd:YAG laser (3 and 6% respectively) especially decreased bleeding and bronchoobstruction. Our experiance and results showed lower complications rate of diode laser, reduced bleeding and bronchoobstruction. Handling and maintenance of diode laser are simpler, easier and most cost-effective, thanks to the undemanding cooling procedure. At the other hand, Nd:YAG laser can offer faster evaporization of larger endoluminal processes. We have to emphasize that further advances and experiences of modified power and density of both diode and Nd:YAG lasers (or even combined), could lead to new qualities a maxbe changes in results presented.

Nd:YAG laser; bronchial obstruction; tracheobronchial pathology

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