^125粒子食管支架在晚期食管癌治疗中的价值研究

Esophageal intraluminal stents with ^125I seeds for advanced esophageal cancer

目的通过观察^125I粒子食管支架对晚期食管癌患者的生存期及生活质量的影响从而评价其疗效。方法采取前瞻性研究方法，对37例接受^125I粒子食管支架治疗的晚期食管癌患者进行随访研究，详细记录患者的生存期，并使用癌症患者生活质量核心量表标准问卷（QLQ-C30）和食管癌专用量表（QLQ-OES18）评价食管支架植入前、植人后1周、植入后3个月时患者的生活质量，并对所得结果进行统计学分析，比较各观察时点间的差异。结果37例患者的3个月生存率为94．6％（35／37），半年生存率为51．4％（19／37）。食管支架植入后1周较支架植入前，QLQ-C30量表中情绪功能、认知功能、总体健康状况、疲倦、疼痛、经济困难得分及QLQ-OES18量表中疼痛得分明显升高（P〈0．05），QLQ-C30量表中恶心呕吐得分及QLQ-OES18量表中吞咽功能、进食不适、咽口水困难、吞咽梗阻得分明显降低（P〈0．05），两量表中其他各项差异无统计学意义（P〉0．05）。食管支架植入后3个月较支架植入前，QLQ-C30量表中经济困难得分仍明显升高（P〈o．05），QLQ-c30量表中恶心呕吐得分及QLQ-OES18量表中吞咽功能、进食不适、咽口水困难、吞咽梗阻得分仍明显降低（P〈0．05），两量表中其他各项差异无统计学意义（P〉0．05）；较支架植入后1周，QLQ-C30量表中经济困难得分及QLQ．OES18量表中吞咽功能、吞咽梗阻得分升高（P〈0．05），QLQ-C30量表中角色功能、情绪功能、认知功能、疲倦得分及QLQ-OES18量表中疼痛得分明显降低（P〈0．05），两量表中其他各项差异无统计学意义（P〉0．05）。结论^125I粒子结合食管支架能够有效延长食管癌晚期患者的生存期，可改善患者的生活质量。

Objective To evaluate the therapeutic effect of esophageal intraluminal stents with ^125I seeds based on survival time and quality of life （QOL） of patients with advanced esophageal cancer. Methods A total of 37 patients with advanced esophageal cancer who underwent placement of esophageal ^125I irradiation stent were followed up. The QOL was evaluated by QLQ-C30 and QLQ-OES18 questionnaires before the procedure, and I week and 3 months after. Results The mean survival time of 37 patients was 28 weeks, with 3-month and 6-month survival rates at 94. 6% （35/37） and 51.4% （19/37）, respectively. Compared with the baseline, the scores of emotional functioning （EF） , cognitive functioning （CF） , global quality of life（QL）, fatigue（ FA）, pain（ PA）, financial difficulties（FI） and pain of QLQ-OES18 （OESPA） assessed 1 week after stent placement increased （ P 〈 0. 05 ） significantly and dysphapia of QLQ-OES18 （ OESDYS）, eating of QLQ-OES18 （ OESEAT）, trouble swallowing saliva of QLQ-OES18 （ OESSV ） and choked when swallowing of QLQ-OES18 （OESCH） decreased significantly （ P 〈 0. 05 ）. At 3 months after stent placement, the scores of FI increased significantly （ P 〈 0. 05 ） , and those of nausea or vomiting （NV） , OESDYS, OESEAT, OESSV and OESCH decreased significantly （ P 〈 0.05 ）. The scores of FI,OESDYS, OESCH, role functioning（RF）, EF, CF, FA and OESPA at 3 months were significantly different from those at 1 week after the procedure （P 〈 0. 05 ）. Other variables at 1 week and 3 months after the pro- cedure were not different from those before （P 〉 0. 05 ）. Conclusion Implantation of ^125I seeds combined with esophageal intraluminal stents may prolong survival time and improve QOL of patients with advanced esophageal cancer.