细直径^(125)I粒子支架在食管癌放疗后复发患者中的应用

Application of small caliber stent loaded with iodine-125 seed in patients with recurrent esophageal cancer after radiotherapy

目的探讨细直径^(125)I粒子支架治疗食管癌放疗后复发的安全性与疗效。方法选取2013年6月至2015年12月在我院收治的食管癌放疗后复发患者16例,在透视下经口腔置入细直径^(125)I粒子支架(直径14 mm或16 mm)。术前及术后对患者吞咽困难进行分级,评估食管狭窄改善情况;支架置入术后1、3、6、12个月及以后每年复查CT或上消化道钡餐评价疗效,并记录不良反应发生情况。结果全部患者均一次性成功置入支架,技术成功率100%。术后患者吞咽困难指数较术前明显改善(P<0.05)。随访期间,3例患者死亡,3例患者出现轻度再狭窄,无大出血、穿孔、感染、放射性肺纤维化等严重并发症。结论细直径^(125)I粒子支架治疗食管癌放疗后复发是安全、有效的方法。

Objective To evaluate the safety and efficacy of small caliber stent loaded with iodine-125 seed in the treatment of patients with recurrent esophageal cancer after radiotherapy. Methods Sixteen patients with recur- rent esophageal cancer after radiotherapy who were treated in our hospital from June 2013 to December 2015 were enrolled. Under fluoroscopy, the small caliber stent （14 or 16 mm in diameter） loaded with iodine-125 seed was insert- ed through the mouth. Dysphagia in patients was graded before and after the operation, and the improvement of esophageal stenosis was assessed. Repeated examination with CT or upper gastrointestinal barium meal was taken at 1, 3, 6, and 12 months after stent placement and then annually to evaluate the treatment efficacy and the occurrence of adverse events were recorded. Results The stents were one-time successfully implanted in all patients, and the tech- nical success rate was 100%. The dysphagia index of the patients was significantly improved postoperatively compared with that preoperatively （P〈0.05）. During follow-up, 3 patients died and 3 patients had mild restenosis. There were no major bleeding, perforation, infection, radiation pulmonary fibrosis and other serious complications. Conclusion Im- plantation of small caliber stent loaded with iodine-125 seed is a safe and effective method in the treatment of recur- rent esophageal cancer after radiotherapy.