支架置入后联合γ-刀放疗对63例老年食管癌生存期的随访研究

Research on survival period of patients had γ-knife radiotherapy after self-expandable metal stents under endoscope for esophageal carcinoma

目的探讨应用内镜球囊扩张带膜金属食管内支架置入联合γ-刀放疗对老年食管癌患者生存期的影响。方法自1999年8月～2006年12月,该科采用国产自膨式镍钛记忆合金网状带膜支架,在电子胃十二指肠镜下对63例老年食管癌患者行球囊扩张带膜金属食管内支架置入术,术后联合γ-刀进行局部放疗,同时以单纯食管内支架置入者为对照,定期复查和随访。结果支架放置成功率和放置后吞咽困难缓解率100%。患者术后随访时间1～60个月,支架置入后联合γ-刀放疗组,生存时间6～45个月,平均9.6个月。单纯内支架置入组,生存时间46d～35个月,平均7.4个月;支架置入后联合γ-刀放疗组平均生存时间显著高于单纯支架置入组。患者在支架置入术后均有局部渗血、胸骨后异物感和疼痛、咽部疼痛症状,部分患者有再梗阻(5例)和食管-气管瘘(1例),未发生呕血、黑便及食管-纵隔瘘等并发症。结论提示内镜球囊扩张带膜金属食管内支架置入术治疗食管癌是安全、有效的、较为理想的姑息方法;近期可以提高患者的生存质量,术后联合γ-刀放疗远期可以延长患者生存时间,提高生存率。

[Objective] To evaluate the survival period of patients with esophageal carcinoma, treated by γ-knife radiotherapy after endoscopic treatment with self- expandable metal stents. [Methods] From Aug.1999 to Dec. 2006, the patients treated by stents placement under gastroduenal endoscope combined with γ-knife radiotherapy （group A） or without （group B） were involved in the study and been regularly followed-up. [Results] 100% was succeeded in the location or diameter of stent placemente. After the patients were followed-up for 1 month to 60 month after treatment, the survival time ranged from 6 month to 45 month （average： 9.6 month） in group A and 6 month to 45 month （average： 7.4 month） in group B. The average survival period in group A was significant higher than that in group B. Major complications, such as oozing of blood （63 cases）, sore-throat （63 cases）, Chest pain or foreign material sensation （63 cases）, reobstuction （5 cases） and tracheo-esophagus fistula （1 case） occurred in these patients, but no heamatemesis, melena and esophagus-mediastium fistula was observed. [Conclusion] Endoscopic therapy with self-expandable metal stents for esophageal carcinomas is safe and effective. It combines with γ-knife radiotherapy can not only raise patients＂ living quality in short period but also prolong their survival-time and increase the survivairates in the long-tenn.