光动力疗法与食管支架置入术改善中晚期食管癌所致吞咽困难的对比分析

Comparison between photodynamic therapy and interventional esophageal stent implantation in dysphagia caused by advanced esophageal cancer

目的比较光动力疗法与食管支架置入术用于改善中晚期食管癌患者恶性梗阻所致吞咽困难的安全性及疗效。方法回顾分析2017年1月至2018年1月在青岛大学附属医院及青岛市黄岛区中心医院就诊的45例中晚期食管癌病例资料,其中男34例、女11例,年龄≥60岁的29例,鳞癌41例,腺癌4例,单纯行光动力治疗20例,单纯行食管支架置入术25例。两组患者性别、年龄、病理类型、部位、分期差异均无统计学意义。在治疗前、治疗后3 d,1、3个月根据吞咽困难Stooler分级标准进行对比,比较两组患者接受治疗后再次出现吞咽困难症状的时间。结果在治疗后3 d,1、3个月吞咽困难分级变化情况差异无统计学意义(均P>0.05),治疗后3 d能正常进食者(0级),食管支架组优于光动力治疗组[40%(10/25)比0(0/20),P<0.05],治疗后1、3个月能正常进食者(0级)所占比例差异无统计学意义(P>0.05),光动力组患者晚于支架组再次出现梗阻症状(P<0.05)。结论食管支架置入术能快速改善吞咽困难症状,光动力疗法在改善吞咽困难症状基础上还能延长患者出现食管再梗阻的时间,治疗中晚期食管癌更安全、有效。

Objective To compare the safety and efficacy of photodynamic therapy(PDT)and esophageal stent implantation in improving dysphagia caused by malignant obstruction of middle and advanced esophageal cancer.Methods A total of 45 patients treated in the Affiliated Hospital of Qingdao University and Qingdao Huangdao District Central Hospital from January 2017 to January 2018 were retrospectively analyzed,of which 34 cases were males and 11 cases were females,29 cases with the age beyond 60 years old,41 cases were squamous carcinoma,4 were adenocarcinoma.PDT was applied to 20 patients and 25 patients received esophageal carotid stenting implantation.There was no significant difference in gender,age,pathological type,location and stage between the two groups.Before treatment,3 days,1 month and 3 months after treatment,dysphagia was compared according to Stooler grading criteria,and also the time that patients experienced dysphagia again post treatment.Results There were no statistical differences between the two groups in dysphagia grade change in 3 days,1 month and 3 months after treatment(all P>0.05),The stent groups showed advantages towards the PDT group 3 days after treatment in patients with Stooler grading 0(40%(10/25)vs 0(0/20),P<0.05).No significant differences were found between two groups with Stooler grading 0(P>0.05)in 1 month and 3 months after treatment.Obstruction symptoms occurred earlier in the stent group compared with the PDT group(P<0.05).Conclusion Esophageal stent can relieve the symptoms of dysphagia immediately after the implantation,while photodynamic therapy can also prolong the time of esophageal re-obstruction in addition to the immediate effect,with proved safety and efficacy in the treatment of middle and advanced esophageal cancer.