三种类型腔内管置管术姑息治疗晚期食管癌的对照研究

Comparative assessment of three prosthesis types for palliative intubation for late stage esophageal carcinoma

目的评价自制腔内管、ＷＣＥＰ系列腔内管、带膜ＧｉａｎｔｕｒｃｏＺ支架三者姑息治疗晚期食管癌的优缺点．方法按应用腔内管的类型不同分成自制管组（６０例）、ＷＣＥＰ组（２２例）、ＳＥＭＳ组（１８例），从置管术条件的需求、技术成功率、吞咽功能改善情况、并发症发生率等方面进行临床对照研究．结果各组的成功率差异无显著性（Ｐ＝０６３３２）．三组吞咽功能置管前无显著性差异（Ｐ＝０２１３５），置管后有明显差异（Ｐ＝０００８７），ＧｉａｎｔｕｒｃｏＺ支架改善吞咽功能较其他两类的腔内管好．三组间术中、术后的并发症发生率均无显著性差异（Ｐ＝０６６３４，０１６３４），但所发生的并发症却明显不同．结论带膜ＧｉａｎｔｕｒｃｏＺ支架改善吞咽功能及阻断食管呼吸道瘘口明显优于管型腔内管．

AIM Comparative assessment of three prosthesis types (self made prosthesis, WCEP, covered Giantucro Z stent) in palliative treatment for advansed esophageal carcinoma. METHODS One hundred consecutive patients (86 men and 14 women) were involved in this study. All patients were classified in to three groups according to the type of prosthesis.Group A was treatecl with self made prostheses (60 patients), Group B with WCEP (Wilson Cook Esophageal Prosthesis, 22 patients), and Group C with covered Giantucro Z stents (18 patients). A comparative study was made on several aspects, including the conditions of intubation, the rate of technical success, the degree of palliative efficacy (expressed as dysphagia score) and the incidence of complications. RESULTS The success rates in group A, B and C were 95 0%, 95 0% and 100 0%, respectively, with no significant difference among the three groups ( P =0 6332). The grade of swallow function in groups A, B and C increased significantly from 3 3±0 6,3 0±0 9,3 4±0 7 to 1 0±0 9, 1 0±1 0,0 3±0 6 after intubation, and improved with 2 3±1 1,2 0±1 4,3 1±0 8, respectively, with no significant difference in the grade of swallow function among three groups before intubation ( P =0 2135),while with significant difference after intubation ( P =0 0087). The improvement in degree of swallow function was better with Gianturco Z stent than with self made prosthese and WCEP. Total incidence of complications was 40%. The complications occurred in 24 patients of group A (24/60,40 0%), 6 of group B (6/22, 22 7%), 10 of group C (10/18,55 5%), the difference had no statistical significance ( P =0 2846). There was no significant difference in the three groups in the early procedure related complications ( P =0 6634) and in the follow up period ( P =0 1634), but in the types of complications. CONCLUSION The covered Giantucro Z stent is an effective and safe alternative of conventional prostheses, obviously better than the self made prostheses and WCEP in the improvement of swallow function, especially in the obstruction of esophagorespiratory fistulas. In contrast to SEMS, the self made prostheses and WCEP (especially the former) are especially suitable for transient utilization and insertion during exploratory thoracotomy.