三种类型腔内管置管术姑息治疗晚期食管癌的对照研究

Palliative Intubation for Late Stage Esophageal Carcinoma:Comparison of Three Types of Prosthesis

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）。３组吞咽功能置管前差异无显著性（Ｐ＝０．２１３５），置管后差异明显（Ｐ＝０．００８７），ＧｉａｎｔｕｒｃｏＺ支架改善吞咽功能较其它两类腔内管好。３组间术中、术后的并发症发生率差异均无显著性（Ｐ值分别为０．６６３４、０．１６３４），但所发生的并发症却明显不同。结论：带膜ＧｉａｎｔｕｒｃｏＺ支架改善吞咽功能及阻断食管呼吸道瘘口明显优于管形腔内管。管形腔内管适用于临时置管及术中置管。

Aim:To compare efficiency of three types of prosthesis(selfmade prosthesis,Wilson Cook esophageal prosthesis(WCEP),covered Giantucro Z stent) in palliative treatment of late stage esophageal carcinoma.Methods:One hundred consecutive patients(86 men and 14 women)were involved in this study.Patients were divided into three groups according to the type of prosthesis used.Group A(n=60) selfmade prostheses,Group B(n=22) WCEP,Group C (n=18) covered Giantucro Z stents.A comparative study was made on several aspects including the conditions of intubation,the rate of technical success,the degree of palliation(expressed as dysphagia score) and the incidence of complications.Results:The successful rates of intubation in group A, group B and group C were 95.0%,95.0% and 100.0%,respectively.It was no significant difference in the grade of swallow function among three groups before intubation(P=0.2135).The grade of swallow function in group A,group B and group C increased significantly from 3.280.64,3.000.88 and 3.390.70 to 0.950.93,0.951.05 and 0.330.59 after intubation(P<0.01).The degree of swallow function was improved better with Gianturco Z stent than with selfmade prostheses and WCEP.The incidence of complications was 40% in this series,including 24 patients in group A(40.0%),6 in group B(22.7%),10 in group C(55.5%).There was no significant difference in three groups in the early procedurerelated complications(P=0.6634),while complications,occurred were different in three groups.Conclusions:The study indicate that covered Giantucro Z stent is an effective and safe alternative of conventional prostheses.It is obviously better than the selfmade prostheses and WCEP in the improvement of swallow function,especially in the management of esophagorespiratry fistulas.In contrast to selfexpanding metalic stent(SEMS),the selfmade prostheses and WCEP are especially suitable as a temporary measure and for insertion during exploratory thoracotomy.