消化管出血に対するレーザー止血法

Endoscopic Laser Coagulation of Gastrointestinal Hemorrhage

　消化管出血に対するレーザー光線による内視鏡的止血法については，1970年頃より西ドイツやアメリカなどから報告されている^1)～7)．遅ればせながら，最近わが国においてもこれについての関心が高まり，限られた施設ではあるが検討されつつある．

　われわれも，1978年から西独MBB社のYAGレーザー（Medilas）を用い，消化管出血に対する止血効果をみてきたので，これまでの経験をもとに見解を述べてみたい．

　In this paper are described the results of fundamental and clinical investigations of controlling bleeding from the digestive tract.

　As a fundamental research we were ahle to check bleeding of the mucosa artificially brought about in a dog when we irradiated laser to it. On an average hemorrhage stopped in 7.4 and 5.5 seconds with an output of 45 W and 60 W, respectively. As there were some cases in which we were unable to control completely bleeding, an output of more than 45 W was considered necessary. In arterial bleeding from the artificially damaged gastric mucosa of the dog the amount of hemorrhage was about 6 ml per minute. Bleeding ceased on an average of 18 seconds with an output of 45 W and 15.7 seconds with 50 W output. As for the question of the width of the diameter of the bleeding mesenteric arteries controllable by laser, we found out that the diameter of up to 1 mm could be managed by laser. The effect of the control of bleeding differed according to the amount of blood flow and its velocity.

　On the basis of the above-mentioned fundamental results we applied them to clinical cases.

　In those disease such as Osler's disease and stress ulcer, where the blood vessels of the lesion are not exposed, bleeding was controlled with relative ease by laser irradiation. We believe it is especially indicated for bleeding from stress ulcer. On the other hand, arterial bleeding of gastric ulcer can be managed at least for the time being, but lasting arrest of hemorrhage could not be expected sufficiently. It was especially difficult to control bleeding from the arteries more than 2 mm in diameter.

　We have described some illustrative cases with reference to the effectiveness and problems of laser coagulation.