放化疗对高龄中晚期食管癌患者肺功能的影响

目的分析47例高龄中晚期食管癌患者放化疗前1周及放化疗后2个月肺功能变化情况,评估肺功能状态。方法选取47例70岁以上中晚期食管癌患者,患者均采用三维适形放疗联合顺铂加紫杉醇化疗,分别比较47例患者放化疗前1周和放化疗后2个月及47例中肺功能正常且无合并症者(正常组31例)与肺功能异常及有合并症者(异常组16例)放化疗前后肺功能各指标变化情况。结果放化疗后2个月,47例患者一氧化碳弥散量(DLCO)较治疗前1周降低[(90.6±16.8)%比(65.8±17.2)%],差异有统计学意义(t=2.0217,P<0.05);其中正常组明显降低[(93.5±15.9)%比(70.6±15.7)%],差异有统计学意义(t=2.0087,P<0.05);异常组降低最明显[(87.3±14.7)%比(56.4±16.5)%],差异有统计学意义(t=2.7406,P<0.01)。而其他肺功能指标放化疗前后变化均不明显,差异无统计学意义。结论放化疗对高龄中晚期食管癌患者肺通气功能损伤较小,但可致弥散功能降低,尤以治疗前肺功能异常且伴有合并症者降低最明显,换气功能损伤最重。

Objective To observe the lung function changes of the lung function conditions in patients with later period esophageal cancer between one week before chemoradiotherapy treatment and two months after chemoradiotherapy treatment. Methods 47 esophageal carcinoma in patients aged over 70 years old, three-dimensional conformal radiotherapy combined with cisplatin plus paclitaxel chemotherapy was applied in all patients. The patients are divided into two groups： normal group, in which there are 31 patients of normal lung function without mergerd diseases; Abnormal group, in which there are 16 patients of abnormal lung function with mergerd diseases. The parameters of lung function for patients in the two groups were compared. Results Compared to one week before chemoradiotherapy treatment, the values of DLCOdecrease for all patients in two months after chemoradiotherapy treatment [ （90.6± 16.8 ） %, （65.8± 17.2 ） %], the result has statistical differences （t=2.0217,P〈0.05 ）. The values of DLCO decrease obviously for the patients in the normal group,the result also has statistical differences [（93.5±15.9）%, （70.6±15.7）%,t=2.0087,P〈0.05]. The values of DLCO are the most obvious to decrease for the patients in the abnormal group,the result also has statistical differences [ （87.3±14.7）%,（56.4±16.5）%,t=2.7406,P〈0.01]. However, the other parameters of lung function are almost unchanged between before chemoradiotherapy treatment and after chemoradiotherapy treatment, and the result has no statistical differences. Conclusions The chemoradiotherapy treatment does little harm to ventilatory function of lung for eld patients with later period esophageal cancer. But it can reduce dispersion function of lung. Especially, it can reduce dispersion function of lung largely for patients with abnormal lung function and mergerd diseases and do severe harm to them.