经内镜下扩张结合食管支架治疗食管恶性梗阻的临床应用

Clinical application of endoscopic expansion combined with esophageal stents to treat esophageal malignant obstruction

目的探讨经内镜下扩张结合食管支架治疗食管恶性梗阻的临床应用。方法回顾性分析2013年1月~2017年12月在我院外科治疗的69例食管恶性梗阻患者的临床资料,均采用经内镜下扩张结合置入食管支架,比较手术前后患者的症状改善情况、生活质量,统计治疗有效率及并发症发生率。结果 69例患者均一次置入支架成功,成功率为100%,术后均可经口进食;8例出现不同程度胸骨后疼痛,2例出现咽部不适及异物感,4例出现食管反流症状,经对症处理后均缓解;术后进食、吞咽困难、反流、梗阻、咳嗽等QLQ-OES18评分较术前明显降低(P<0.05),疼痛、口干、咽口水、言语、食欲缺乏等无明显改善(P>0.05);术后患者的角色功能、躯体功能、社会功能、情绪功能、疲乏、总体状况等QLQ-C30评分较术前明显升高,差异均有统计学意义(P<0.05),而认知功能、恶心呕吐、疼痛评分改善,差异无统计学意义(P>0.05)。结论经内镜下扩张结合食管支架治疗食管恶性梗阻的临床效果确切,能有效扩张食管,改善患者进食状况,促进生活质量的提高,具有积极的临床意义。

Objective To explore the clinical application of endoscopic expansion combined with esophageal stents to treat esophageal malignant obstruction. Methods The clinical data of 69 patients with malignant esophageal obstruction treated in our hospital from January 2013 to December 2017 were retrospectively analyzed, all patients were treated with endoscopic dilatation combined with esophageal stent placement. Before and after surgery, symptom improvement,quality of life, effective rate of statistical treatment and incidence of complications were compared. Results In all 69 patients, the stents were successfully implanted at one time, and the success rate was 100%, oral feeding had after surgeny. The symptoms of esophageal reflux were found in 8 patients with different degrees of retrosternal pain, 2 cases with pharynx discomfort and foreign body sensation, 4 cases which could be alleviated after symptomatic treatment. The QLQ-OES18 scores of eating, dysphagia, regurgitation, obstruction and cough after operation were significantly lower than those before operation（P〈0.05）. There was no significant improvement in pain, dry mouth, pharyngeal saliva,speech and anorexia（P〈0.05）. The QLQ-C30 scores of role function, somatic function, social function, emotional function, fatigue and general condition were significantly improved than those before operation（P〈0.05）, but the scores of cognitive function, nausea, vomiting and pain were not significantly improved（P〈0.05）. Conclusion Endoscopic dilatation combined with esophageal stents in the treatment of malignant esophageal obstruction is effective in the treatment of esophageal obstruction, can effectively expand the esophagus, improve the food status of patients, improve the quality of life, has a positive clinical significance.