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食管癌动脉灌注化疗后严重并发症的预防和治疗 被引量:8

Treatment and prevention of serious complications after arterial perfusion chemotherapy of esophageal cancer
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摘要 目的 探讨食管癌动脉灌注化疗后严重并发症的发生原因及其预防措施。方法  36 8例食管癌患者接受经动脉灌注化疗药物治疗 ,共行灌注化疗 90 9次。均经食管吞钡X线片及食管细胞学或病理组织学检查证实为食管癌患者。全部病例均采用Seldinger技术行相应食管节段的供血靶动脉选择性插管和造影 ,并经导管灌注化疗药物。结果 动脉灌注化疗后出现脊髓损伤致截瘫 1例 ,食管穿孔2例 ,坏死性食管炎 3例。截瘫病例经 1个月治疗未恢复 ,2个月后死于原发病 ;食管穿孔中 1例形成食管 气管瘘 ,植入食管覆膜内支架后生存 8个月 ,1例形成食管 纵隔瘘 ,6周后死于食管大出血 ;3例坏死性食管炎均发生在正常食管段 ,均形成食管穿孔。其中 1例形成食管 支气管瘘 ,行胃造瘘后至今生存 ,2例形成食管 纵隔及食管 支气管瘘 ,均死于严重感染。结论 食管癌动脉灌注化疗后严重并发症少见 ,但后果严重。离子型对比剂是发生脊髓损伤的主要原因。化疗药物的细胞毒性作用和组织耐受性是食管穿孔的主要原因。 Objective To investigate the cause of severe complications after arterial perfusion for esophageal cancer and the methods of prevention. Methods 368 cases of esophageal cancer were treated with arterial perfusion of drugs for chemotherapy. The treatment numbers were 909 including 215 males and 153 females with the age ranging from 39 to 86. These patients were verified as esophageal cancers histopathologically. Selective angiography of the relevant esophageal segments and drugs for perfusion chemotherapy were undertaken. Results The complications included one case of paralysis due to spinal cord injury, two cases with esophageal perforation and three cases of necrotic esophagitis. The case of paralysis died of original disease one month after the treatment. Of the cases of esophageal perforation, one formed the esophgus-trachea fistula and survived for eight months after being esophageal stent implantation and the other formed esophagus-mediastinum fistula and died of massive hemorrhage after six weeks. Three cases of necrotic esophagitis occurred at the normal segments of the esophagus and formed esophgeal perforation. Of these three cases, one formed esophago-broncheal fistula and survived up to now after creating drainage stoma of stomach. Two cases of the esophgus-mediastinum and esophgus-bronchius fistula died of severe infection. Conclusions Severe complications of esophageal arterial catheterization with drugs for chemotherapy are rare. Less harmful, non-ionization contrast medium, low cellular toxicity drugs for chemotherapy with proper doses and concentrations should be selected together with optimal speed of infusion. Esophageal internal stent placement drainage stoma creation of stomach should be the useful adjunct for severe complications.
出处 《介入放射学杂志》 CSCD 2004年第5期417-420,共4页 Journal of Interventional Radiology
关键词 食管癌 动脉灌注化疗 并发症 预防 治疗 Radiology, intervention Esophageal tumour Catheterization, complication Hurt of spinal cord Esophageal performation
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参考文献4

  • 1宋太民,李天晓,张耀勇,孙玉枝,文凌娟,马会军,牛松涛,王瑞林.选择性动脉插管灌注化学药物治疗中晚期食管癌[J].中华放射学杂志,2003,37(1):37-42. 被引量:26
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二级参考文献7

  • 1上田英二(白振明摘译).抗癌剂动脉灌注化疗法对血管影响的基础研究[J].国外医学:临床放射学分册,1990,13:312-312.
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  • 7宋太民,张跃勇,韩照豫,孙玉枝,李天晓,王瑞林.食管癌选择性动脉造影和肿瘤供血的研究[J].实用放射学杂志,1999,15(9):534-536. 被引量:11

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