老年与非老年食管癌患者经影像学引导下经皮胃造瘘术治疗中的效果比较

Comparison of clinical outcomes of percutaneous radiologic gastrostomy in elderly and non-elderly patients with esophageal cancer

目的比较分析经影像学引导下经皮胃造瘘术(percutaneous radiologic gastrostomy,PRG)治疗老年及非老年食管癌患者的安全性和临床预后。方法回顾性分析2014年7月至2018年7月间于郑州大学附属肿瘤医院行PRG治疗的食管癌患者150例,其中84例年龄<70岁者为A组,66例年龄≥70岁为B组。比较分析两组的术后总生存期、手术成功率、并发症发生率、手术相关死亡率、术后营养指标及免疫指标的变化的差异。结果 A组中位生存期180 d,B组中位生存期170 d。Kaplan-Meier曲线显示,两组生存率差异无统计学意义(P=0.283)。两组手术成功率均为100%,两组患者均无胃造瘘术相关死亡。术后两组30 d内分别死亡3例,A组3例,B组3例。术后发生造瘘口感染3例,A组1例,B组2例。术后消化道出血5例,A组2例,B组3例。造瘘管移位11例,A组5例,B组6例。术后吸入性肺炎共22例,A组16例,B组6例。共有14例需要额外治疗,A组7例,B组7例。术后1~2个月,血清白蛋白变化平均值A、B两组分别为(-2.4±8.2)、(-2.7±5.5)g/L,体质量变化平均值A、B两组分别为(-0.41±1.32)、(-0.45±2.14)kg,淋巴细胞变化平均值A、B两组分别为(-0.47±3.6)×10~9/L、(-0.45±2.9)×10~9/L。两组的手术成功率、术后30 d内死亡率、并发症发生率、附加治疗次数,以及术后1~2个月血清白蛋白值、体质量值和淋巴细胞计数的变化差异均无统计学意义(P> 0.05)。结论 PRG治疗老年与非老年食管癌人群的临床预后相仿。

Objective To compare the clinical outcomes of percutaneous radiologic gastrostomy(PRG)in elderly and non-elderly patients with esophageal cancer. Methods A total of 150 cases with esophageal cancer who underwent PRG treatment in Affiliated Tumor Hospital of Zhengzhou University from July 2014 to July 2018 were retrospectively analyzed. Group A invlovled 84 patients aged < 70 years old,and group B 66 patients aged ≥70 years old. Clinical outcomes,including overall survival,operation success rate,operational mortality,procedural complications,postprocedural body weight,postprocedural nutritional status and needs for additional intervention were compared between the two groups. Results The median survival time of group A and B was 180 days and 170 days respectively and Kaplan-Meier curve showed no significant difference in survival between the two groups(P = 0.283). The operation success rate of the two groups was both 100%. There was no operational mortality in both groups but 3 patients in each group died within 30 days after the operation. Incision infection occurred in3 cases after the operation,with 1 in group A and 2 in group B. Postoperative gastrointestinal bleeding occurred in5 cases,with 2 in group A and 3 in group B. Catheter dislodgement occurred in 11 cases,with 5 in group A and 6 in group B. Postoperative aspiration pneumonia occurred in 22 cases,with 16 in group A and 6 in group B. A total of 14 patients required additional treatment,with 7 in group A and 7 in group B. The mean changes of serum albumin value 1-2 months after the operation was(-2.4 ± 8.2)g/L in group A and(-2.7 ± 5.5)g/L in group B. The mean changes of body weight 1-2 months after the operation was(-0.41 ± 1.32)kg in group A and(-0.45 ± 2.14)kg in group B. The mean changes of serum lymphocyte count 1-2 months after the operation was(-0.47 ± 3.6)× 10~9/L in group A and(-0.45 ± 2.9)× 10~9/L in group B. The differences in operation success rate,operational mortality,procedural complications,changes in postprocedural body weight,serum albumin value,serum lymphocyte count and needs for additional intervention were not significant(P > 0.05). Conclusion There is similar clinical outcome of PRG in the treatment of elderly and non-elderly esophageal cancer patients.