食管覆膜支架置入术和球囊扩张术在治疗中晚期食管癌中的临床价值探讨

The clinical value of esophageal stent implantation and balloon dilatation in the treatment of advanced esophageal cancer

目的:探究中晚期食道癌应用食管覆膜支架置入和球囊扩张术治疗的临床应用价值。方法:对我院收治中晚期食道癌患者110例进行回顾性分析,治疗前本组病例均有病理活检,患者均为不能手术或拒绝手术的患者。所有患者术前均行X线检查,确定病变部位、狭窄长度及与周围组织关系,本组病例均有在术前或术后配合化疗或放射治疗的情况。对110例患者分组,30例患者置入覆膜支架,对30例患者进行球囊扩张,对50例患者不分先后做了食管覆膜支架置入术和球囊扩张术。以术后狭窄扩张效果、生存质量及相关并发症进行比较分析。结果:支架置入成功率100%,平均生存期12个月,食道球囊扩张均经1~3次扩张达到预期效果,成功率70%,生存率9个月,食管覆膜支架置入术联合球囊扩张术治疗中晚期食道癌,总有效率100%,生存期平均16个月。结论:食管覆膜支架置入术联合球囊扩张术,在治疗中晚期食管癌能相对延长患者生存时间、提高生存质量方面明显优于单纯食道食管覆膜支架置入术及单纯球囊扩张术,患者疗效更高,具有理想的临床价值。

Objectives To evaluate the clinical benefit of esophageal stent placement combined with balloon dilation in the treatment of advanced esophageal cancer.Methods A total of 110 patients with advanced esophageal cancer were analyzed retrospectively in our hospital.The cases were selected based on the following criteria:1) pathological confirmed diagnosis;2) unresectable tumor and/or refusion of surgical treatment.Barium X-ray examination was also conducted to assess the tumor length,location and adjacent normal tissues.All the patients received pre/post-palliative treatment chemotherapy and/or radiotherapy.The 110 patients were divided into three groups,esophageal stent placement (group A,n=30),esophageal balloon dilation (group B,n=30) and esophageal stent placement combined with balloon dilation (group C,n=50).The outcomes were evaluated in terms of technical success,esophageal recanalization,quality of life,major complications and overall survival.Results The technical success rate of group A was 100% and the median survival was 12 months.For group B,the expected efficacy could be achieved after 1~3 times of balloon expansion,characterized by the success rate of 70% and the median survival of 9 months.The total effectiveness of group C was 100% and the average survival time was 16 months.Conclusions With superior clinical benefit compared with the single use of esophageal stent or balloon dilation,esophageal stent placement combined with balloon dilation can offer longer overall survival and higher life quality of patients with advanced esophageal cancer.