内镜下放置食管带膜镍钛记忆金属支架姑息治疗晚期食管癌疗效观察

Palliative treatment of late-stage esophageal carcinoma by placement of covered Ni- Ti Alloy stents under endoscopy

目的：观察和评价内镜下放置食管镍钛记忆金属带膜支架，姑息治疗晚期食管癌吞咽困难和食管气管瘘 /纵隔瘘的疗效、并发症及对生存期的影响。方法：治疗组胃镜下（部分进导丝时合用 X线监视）放置国产和进口镍钛记忆金属带膜支架 21例。共放置支架 25枚，其中国产 21枚，进口 4枚。对照组为我院收治的 27例晚期食管癌吞咽困难患者，行胃造瘘和静脉营养姑息治疗。结果：治疗组 24枚支架安置定位准确，扩张满意， 1枚位置偏高 1.0 cm。食管最狭窄处内径由 (1.86± 2.69) mm扩至 (13.91± 1.81) mm，食管气管瘘／纵隔瘘被覆盖阻断。吞咽困难评级（ 0～ 4级）由平均 3.48± 0.75降至 0.90± 0.54。术后一周生活质量评分（ Karnofsky）平均提高 30.09± 5.08。治疗组和对照组的半年生存率为 71.43％与 11.11％， 1年生存率为 14.29％与 0，中位生存期为 7个月与 3个月， Log- rank检验，两组差异有统计学意义（ P<0.0001)结论：该方法简便、准确、安全，明显改善吞咽困难，提高生活质量，延长生存期。

Objective： The current study was designed to evaluate the outcomes and complications of palliative treatment which alleviate dysphagia and symptoms of esophagotracheal or esophagomediastinal fistulas for late- stage esophageal carcinoma by placement of covered Ni- Ti Alloy stents under endoscopy and discuss the effects of this treatmeut on survival. Methods： Twenty- one cases of late- stage esophageal carcinoma which were treated by placement of covered Ni- Ti Alloy stents under endoscopy were included in this group. Twenty- five stents were placed among these patients, including 21 stents made in China and 4 imported. Control group was 27 cases of late- stage esophageal carcinoma who suffered from dysphagia and were treated by gastrostomy and intravenous nutrition. Results： Twenty- four stents were placed correctly with satisfying dilatation in treatment group, while 1 stent was placed 1.0 centimeter above its expected position. The shortest diameter of esophagostenosis was expanded from (1.86± 2.69) mm to(13.91± 1.81)mm and esophagotracheal or esophagomediastinal fistulas were also occluded by the stents. The grades of dysphagia(grade 0－ 4) were lowered from(3.48± 0.75) to (0.90± 0.54). Karnofsky performance score was increased 30.09± 5.08 one week following operation. The half- year survival rates of treatment group and control group were 71.45％ and 11.11％ , respectively; one year survival rates of these two groups were 14.21％ and 0, respectively,and the mean survival durations were 7 months and 3 months, respectively; Log- rank test showed there was statistical significance between these two groups. Conclusions： This treatment is simple and safe for patients with late- stage esophageal carcinoma and can greatly alleviate dysphagia, improve life quality and prolong survival time.