内镜下自膨式金属网状支架植入术治疗食管恶性狭窄182例疗效分析

Endoscopic self-expanding metallic mesh stent implantation for the treatment of malignant esophageal strictures: efficacy analysis of 182 cases

目的:评价自膨式金属网状支架(SEMS)植入术治疗食管恶性狭窄的临床疗效及操作要点,并探讨SEMS植入后是否应联合放疗和(或)化疗。方法:根据是否在置入SEMS基础上接受放疗和(或)化疗,182例食管恶性狭窄患者分为单纯置入组(77例)和综合治疗组(105例)。结果:所有患者均一次性置入支架成功。术后生存30 d者,全身营养不良状况明显改善,平均体重增加7.2 kg;综合治疗组生存期分级明显优于单纯置入组(P<0.01),但已有远处转移灶的患者两组之间无明显差异(P=0.579)。术后生存3个月以上者,再狭窄发生率综合治疗组显著低于单纯置入组(P=0.026)。结论:SEMS置入术是治疗晚期食管恶性狭窄的一种安全、有效、简便的姑息性治疗方法,联合放疗和(或)化疗等综合性治疗措施,可提高患者生活质量,延长生命,但对已出现明显转移灶的患者价值不大。

Objective To evaluate the clinical efficacy and the operation of self-expanding metallic mesh stents （SEMS） implantation for the treatment of malignant esophageal strictures, and to explore whether SEMS implantation should be combined with radiotherapy and/or chemotherapy in the treatment of malignant esolc Based on SEMS implantation in accordance with whether or not to accept the basis of radioth hageal stenosis. Methods erapy and/or chemothera- py, 182 cases of patients with malignant esophageal strictures placed into a simple implantation group （77 cases） and the integrated treatment group （105 cases）. Results All patients were one-time successfully stented. After 30 days, systemic malnutrition was significantly improved with an average weight gain of 7.2 kg; integrated treatment group survived significantly better than simple implantation groups （P 〈0.01 ）, but among those with distant metastasis, no significant difference was seen between the two groups （P = 0. 579）. Survivors of more than three months or more had a geal strictures. If combined with radiotherapy and（or） chemotherapy, such as a comprehensive treatment, patients can improve quality of life, prolong life, but it has limited value for the apparent metastasis patients.