125I粒子食管支架治疗食管癌术后食管再狭窄的疗效与安全性

Clinical effect and safety of 125I particle stent on treatment of postoperative esophageal stricture for patients with advanced esophageal cancer

目的 探讨125I粒子食管支架治疗食管癌术后食管再狭窄的疗效与安全性.方法 收集60例本院就诊的食管癌术后食管再狭窄患者,采用随机数字分组法分为对照组和照射组,每组30例.对照组和照射组患者分别接受普通自膨式支架和125 I粒子自膨式支架植入治疗.术后计算支架植入成功率;术后1周和2个月对2组患者进行吞咽困难评分,判断食管狭窄改善情况;观察术后6个月2组患者的并发症;随访18个月,观察2组患者的生存情况.计量资料采用t检验进行比较,计数资料的比较行x2检验.结果 2组患者的支架均一次植入成功,成功率均为100％（30/30）.术前吞咽困难评分,0、1、2、3、4分者对照组为分别为0、2、3、22和3例,照射组分别为0、2、2、23和3例;术后1周对照组上述评分分别为1、17、6、6和0例,照射组分别为4、21、3、2和0例,组间差异无统计学意义（P=0.675）;术后2个月对照组上述评分的患者分别为25、3、2、0和0例,照射组分别为27、2、1、0和0例,组间差异也无统计学意义（x2=1.043,P=0.894）.随访6个月,对照组出现消化道出血1例、疼痛4例、食管再狭窄8例,照射组出现上述并发症的患者分别为0、5和3例,照射组术后食管再狭窄发生率低于对照组,差异有统计学意义（x2=4.384,P=0.036）.随访18个月.对照组30例患者中10例存活,20例死亡患者的生存期为2.0 ～ 14.0个月,平均（4.8±1.7）个月;照射组30例患者中15例存活,15例死亡患者的生存期为4.0～15.0个月,平均（9.8±2.9）个月,照射组患者的平均生存时间长于对照组,差异有统计学意义（t=8.917,P=0.002）.结论 125I粒子支架在不增加并发症的同时能明显改善晚期食管癌患者食管狭窄症状和延长患者的生存期.

Objective To investigate clinical effect and safety of the 125I particle stent for treatment of postoperative esophageal stricture on patients with advanced esophageal cancer.Methods Sixty patients with postoperative esophageal stricture after esophageal cancer operation were randomly assigned to receive treatment with a conventional self-expanding stent （control group） or a stent loaded with 125I seeds （irradiation group）.After stent implantation,the outcomes were compared in terms of the success rate of stent implantation,relief of dysphagia,survival time,and complications related to the procedure.Dysphagia was assigned a grade 0-4.The t test and the x2 test were used to make statistical analysis.Results The success rate of stents placement of two groups were 100％ （30/30）.The results of preoperative dysphagia score showed that the patients of control group with 0,1,2,3,4 degree were 0,2,3,22 and 3 patients ; the patients of radiation group with 0,1,2,3,4 degree were 0,2,2,23 and 3 patients; in postoperative 1 week,the control group turned to 1,17,6,6 and 0 patients,the radiation group turned to 4,21,3,2 and 0 patients ; the difference between the 2 groups was not statistically significant （x2 =1.214,P =0.675） ; in postoperative 2 months,the patients with the above degree of dysphagia score of control group were 25,3,2,0,0; and the radiation group were 27,2,1,0,0,the difference between the 2 groups was not statistically significant （x2 =1.043,P =0.894）.Followed up for 6 months,1 patient gastrointestinal bleeding,4 patients gastrointestinal pain and 8 patients esophageal restenosis were occurred in control group,corresponding in irradiated group were 0,5,and 3 patients respectively,the incidence of postoperative esophageal restenosis of irradiated group was lower than control group,and the difference was statistically significant （x2 =4.384,P =0.036）.After follow-up for 18 months,10 patients were survival among the 30 patients of control group,the live time of the 20 patients dead patients were 2 to 14 months,control group of 30 patients,10 patients of survival of 20 deaths of patients from 2 to 14 months,the average value was （4.8± 1.7）months ; there were 15 survival patients among irradiation group,the survival time of the 15 deaths was 4 to 15 months,and the average value was （9.8 ± 2.9） months.By the end of follow-up,the average survival time for all patients of irradiated group was longer than the control group,the difference was statistically significant （t =8.917,P =0.002）.Conclusion In patients with postoperative esophageal stricture and advanced esophageal cancer,stent loaded with 125I stent has potential benefit in that it allows a longer relief of dysphagia and a longer survival time.