携带化放疗微粒支架置入治疗食管癌的临床应用

The Clinical Application of Carrying Chemoradiotherapy Particles Stents Treatment in Esophageal Cancer

目的:探讨一次性将同时携带化疗微粒和I125微粒的覆膜食管支架微创置入治疗食管癌的可行性及疗效。方法:对于出现梗阻症状的中晚期食管癌患者,根据病变的范围、浸润深度,计算机治疗计划系统(treatment plan system TPS)计算出所需的剂量,将I125微粒置于覆膜食管支架的外周捆绑悬挂式"弹仓"内,同时将化疗微粒用丝线捆绑在悬挂式"弹仓"的间隙中,在C形臂显示下将携带有化放疗粒子的食管支架一次性置入病变部位,然后经鼻腔置入螺旋形鼻肠营养管到十二指肠以下部位,术后给予全胃肠高营养1周后进半流食。结果:携带化疗微粒和I125微粒的覆膜食管支架均一次性置入到位。术中患者无出血等并发症。术后经过全胃肠高营养的支持治疗,患者营养状况逐渐恢复,血象未见异常变化,血生化和免疫指标逐渐恢复正常。术后复查CT,无粒子移位、脱落现象。病灶向内外浸润程度好转。结论:一次性将同时携带化疗微粒和I125微粒支架治疗有癌性狭窄的中晚期食管癌是安全、有效、可行的,它具有创伤小、并发症少等特点;更主要的是,不仅解决吞咽困难的问题,同时又能抑制肿瘤的进一步发展。相互弥补了放化疗对肿瘤的治疗缺陷,最大限度的提高了肿瘤对放化疗的敏感度,减少术后全身放化疗的剂量,减少毒副作用,提高生存质量、延长生存期。

Objective： To detect the technical feasibility and efficacy of placing Coated esophageal stents carrying chemoradiotherapy particles and I125 particles in esophageal cancer together. Method.According to the extent and invasion depth of the tumor, treatment plan system TPS calculate the required dose, for advanced esophageal cancer patients with obstructive symptoms. We put I125 particles in the coated esophageal stent, which we bundled in esophageal stent peripheral hanging＂magazine＂, whose gap Chemotherapy particles is bun- dled in with the silk, then we put esophageal stent carrying the chemoradiotherapy particles in the placement of the lesion guided in the C- arm at once. And then spiral nose intestinal feeding tube is placed to the following parts of the duodenum through the nose. Patients are given total parenteral nutrition after surgery for a week, then begin to take the semi - liquid food. Results： All of the coated esophageal stents carrying chemotherapy par- ticles and 112s particles are put into place at once. All the patients had no bleeding and other complications during surgery. The nutritional condition of the patients gradually recoveres after total parenteral nutrition. There is no abnormal changes in the patient＇s blood count, biochemical and immunological indicators of the patient＇s blood, gradually return to normal. The patients are given review of CT, then we discover there is no phenomenon of particle of displacement and shedding after surgery, and the degree of the inside and outside infiltration of Lesion improves. Conclusion：It is safe and feasible the coated esophageal stents carrying chemotherapy particles and I125 particles are put into place at once, which is treated for advanced esophageal cancer patients with obstructive symptoms, and it has a small wound, fewer complications and so on, which not only solve the problem of difficulty in swallowing, but also inhibit the further development of the tumor more importantly Coated esophageal stents carrying chemoradiotherapy particles and I125particles make up for the treatment of tumor defects of chemotherapy or radiative therapy each other, Which maximum increase the tumor sensitivity for radiotherapy and chemotherapy, reduce the dose in systemic chemotherapy after surgery and reduce side effects, which both improve the quality of life and prolong survival, and which achieve the purpose of a governance table and a permanent cure.