支架置入术联合放射治疗晚期食管癌的临床价值

Treatment of Late Stages of Esophageal Carcinoma with Combination of Metal Stenting and Radiotherapy

目的评价食管记忆镍钛合金支架置入术联合放射治疗晚期食管癌的临床价值。方法对107例晚期食管癌并狭窄、穿孔、瘘病人分别行镍钛合金带膜记忆支架置入术和支架联合放射治疗,比较单纯支架治疗和联合放射治疗病人的生存率和疗效。结果晚期食管癌并单纯狭窄患者12、24个月的生存率:联合放疗组和单纯支架组分别为22.91%(11/48)、14.58%(7/48)和12.5%(7/56)、0.00%(0/56),联合放疗组明显高于单纯支架组,2组比较差异有显著性意义(P<0.01);而晚期食管癌合并穿孔、瘘的患者6、9个月的生存率:联合放疗组和单纯支架组分别为33.33%(2/6)、0.00%(0/6)和50.00%(4/8)、25.00%(2/8),联合放疗组明显低于单纯支架组,2组比较差异有显著性意义(P<0.01),2组患者生存期无1例超过12个月。联合放疗组并发症总体发生率高于单纯支架组。结论晚期食管癌并单纯狭窄,联合放疗能明显提高患者生存期,而晚期食管癌合并穿孔、瘘的患者则不适宜联合放疗。

Objective To study clinical feasibility and results of endoscopic metal stenting combined with radiotherapy in treatment of late stages of esophageal carcinoma. Methods 107 cases of late stages of esophageal carcinoma were randomized into two groups ：one treated with stent implantation only, another combination of stent and radiotherapy . Clinical efficacy and survival rates of two groups were compared. Results The survival rates of 12 and 24 months of patients of esophageal stricture with stent implantation and radiotherapy were 22.91% （ 11/48 ） and 14.58% （7/48） significantly higher than those of patients with stent implantation （ 12.5% （7/56） ,0.00% （0/56）） （ P 〈 0.01 ）. The 6 and 9 months survival rates of patients of esophageal fistula with stent implantation were 50.00% （4/8） and 25.00% （ 2/8 ） significantly higher than those of patients with stent implantation and radiotherapy （ 33.33 % （2/6） ,0.00% （ 0/6 ） ） （ P 〈 0.01 ）. But the complication rates of group B were higher than group A. Conclusion Endoscopic metal stenting in combination with radiotherapy improved the survival rates in treatment of late stages of esophageal carcinoma with only stricture,but it did not be used latein stages of esophageal carcinoma with fistula.