食管癌放疗后良性狭窄的相关因素分析

Analysis of risk factors of esophageal benign stricture after radiotherapy for esophageal carcinoma

目的研究食管癌放疗后食管良性狭窄形成的影响因素。方法2010-01—01-2013—06—30常州肿瘤医院71例原发性食管癌患者接受了放疗或放化疗联合治疗。治疗后定期随访，通过食管钡餐造影检查评价食管狭窄情况，计算狭窄率，观察食管狭窄峰值出现的时间，并对患者的临床病理学因素进行相关性分析。结果中位随访时间23个月。食管狭窄程度〉75％的10例（14．1％），50％～75％的14例（19．7％），25％～50％的31例（43．7％），〈25％的16例（22．5％）。以患者年龄、肿瘤位置、T分期、周在性、纵轴长度、是否化疗和放疗剂量等变量用为评价指标。羊因素分析提示，T分期和周在性为狭窄发生的相关因素，P值均〈0．001。多因素分析结果显示，T分期和周在性对放疗后食管狭窄差异有统计学意义，P值均为0．003。结论随着T分期和周在性的增加，食管癌放疗后狭窄程度逐渐增加。

OBJECTIVE To identify the factors which cause esophageal benign stricture after radiotherapy for e sophageal carcinoma. METHODS Seventy one primary esophageal carcinoma patients got radiotherapy or a combination of chemotherapy and radiotherapy from Janauary 1st 2010 to June 30th 2013. Some regular examinations were taken after the treatment, including barium radiographs, evaluation of the stricture degree, and calculation of the stricture rate and observing the time of stricture peak value. Meanwhile, correlation analysis was used to esophageal stricture with age, tumor position, T stage, roundness, longitudinal length, radiation dose and inclusion of chemotherapy. RESULTS The median follow-up time was 23 months. Degrees of stenosis〉75%was in the 10 cases （14.1%）,50%-75% in 14 cases （19.7%）,25%--50% in 31 cases （43.7%）. The stenosis 〈 25% was in 16 cases （22.5%）. The age, tumor location, T stage, roundness, the length, chemotherapy and radiotherapy in these patients were studied. Single factor analysis showed that T stage, roundness and non-chemotherapy were all correlative factors （P values were both〈0. 001）. And the conclusion of multiple analysis appeared that roundness and T stage were of great significance to esophageal stricture after radiotherapy for esophageal carcinoma （P values were both 0. 003）. CONCLUSION The incidence of esophageal stricture grows with the improvement of T stage and the roundness.