不同支架治疗晚期食管癌患者的疗效观察

Observation on the efficacy of different stents in the treatment of patients with advanced esophageal cancer

目的探讨内镜下普通支架植入与放射性125I粒子支架植入治疗晚期食管癌的疗效与安全性。方法回顾性分析2014年12月至2020年12月陕西省靖边县人民医院、西安医学院第一附属医院、空军军医大学西京消化病医院、陕西省榆林市第一医院收治的晚期食管癌患者的临床资料,根据植入支架类型的不同分为普通支架组(n=66)和放射性粒子支架组(n=34)。比较两组患者术后并发症、Karnofsky功能状态(KPS)评分、吞咽困难评分、再狭窄发生率及生命质量。结果普通支架组和放射性粒子支架组患者术后胸骨后疼痛发生率分别为65.2%(43/66)和47.1%(16/34),咽部疼痛、声音嘶哑发生率分别为12.1%(8/66)和5.9%(2/34),腹痛发生率分别为9.1%(6/66)和2.9%(1/34),渗血发生率分别为3.0%(2/66)和2.9%(1/34),恶心、呕吐发生率分别为7.6%(5/66)和5.9%(2/34),差异均无统计学意义(χ^(2)=3.04,P=0.081;χ^(2)=0.40,P=0.527;χ^(2)=0.53,P=0.467;χ^(2)<0.01,P>0.999;χ^(2)<0.01,P>0.999)。两组患者术后1、2、3、6个月的KPS评分均高于术前(均P<0.05);放射性粒子支架组术后2、3、6个月的KPS评分均显著高于普通支架组[(89.73±7.84)分比(82.37±7.42)分,t=4.62,P<0.001;(93.63±8.13)分比(88.33±7.28)分,t=3.74,P<0.001;(92.78±6.26)分比(87.28±8.73)分,t=3.77,P<0.001]。两组患者术后1、2、3、6个月的吞咽困难评分均低于术前(均P<0.05);放射性粒子支架组术后第3、6个月吞咽困难评分均显著低于普通支架组[(0.68±0.12)分比(2.33±0.32)分,t=26.20,P<0.001;(0.82±0.22)分比(2.67±0.24)分,t=36.92,P<0.001]。术后3个月放射性粒子支架组再狭窄发生率显著低于普通支架组[5.88%(2/34)比42.4%(28/66),χ^(2)=14.27,P<0.001]。两组患者术后1、2、3、6个月QLQ-C30和OES-18量表得分均低于术前(均P<0.05);放射性粒子支架组患者术后2、3、6个月的QLQ-C30量表得分显著低于普通支架组[(19.12±3.02)分比(21.22±2.87)分,t=3.39,P=0.001;(15.04±1.68)分比(20.43±2.23)分,t=12.39,P<0.001;(14.38±2.18)分比(19.77±3.67)分,t=9.20,P<0.001],OES-18量表得分亦显著低于普通支架组[(17.13±2.07)分比(20.64±2.11)分,t=7.95,P<0.001;(15.22±1.88)分比(19.24±1.76)分,t=10.62,P<0.001;(14.74±2.36)分比(18.53±3.27)分,t=6.01,P<0.001]。结论放射性粒子支架植入在晚期食管癌伴狭窄患者中能提高生命质量,改善吞咽困难,降低术后再狭窄发生率,但在延长生存期、减少并发症等方面是否明显优于普通支架还需进一步采用多中心、前瞻性、大样本的随机对照研究证实。

Objective To explore the efficacy and safety of treating advanced esophageal cancer by implanting the common stent and the radioactive 125I particle stent with endoscope.Methods The clinical data of patients with advanced esophageal cancer admitted to Jingbian County People's Hospital of Shaanxi Province,the First Affiliated Hospital of Xi'an Medical University,Xijing Hospital of Digestive Diseases of Air Force Medical University and the First Hospital of Yulin of Shaanxi Province from December 2014 to December 2020 were retrospectively analyzed.Patients were divided into common stent group(n=66)and radioactive particle stent group(n=34)according to different stent types.The postoperative complications,Karnofsky performance status(KPS)score,dysphagia score,restenosis rate and quality of life were compared between the two groups.Results The incidences of postoperative retrosternal pain in the common stent group and the radioactive particle stent group were 65.2%(43/66)and 47.1%(16/34)respectively.The incidences of pharyngeal pain and hoarseness were 12.1%(8/66)and 5.9%(2/34).The incidences of abdominal pain were 9.1%(6/66)and 2.9%(1/34).The incidences of errhysis were 3.0%(2/66)and 2.9%(1/34).The incidences of vomiting and nausea were 7.6%(5/66)and 5.9%(2/34)respectively.There were no statistically significant differences between the two groups(χ^(2)=3.04,P=0.081;χ^(2)=0.40,P=0.527;χ^(2)=0.53,P=0.467;χ^(2)<0.01,P>0.999;χ^(2)<0.01,P>0.999).In the two groups,KPS scores in the first,second,third and sixth month after operation were higher than those before operation(all P<0.05).KPS scores of the radioactive particle stent group in the second,third and sixth month were significantly higher than those of the common stent group[(89.73±7.84)points vs.(82.37±7.42)points,t=4.62,P<0.001;(93.63±8.13)points vs.(88.33±7.28)points,t=3.74,P<0.001;(92.78±6.26)points vs.(87.28±8.73)points,t=3.77,P<0.001].The dysphagia scores of patients in the two groups in the first,second,third and sixth month were lower than those before operation(all P<0.05).The dysphagia scores of the radioactive particle stent group in the third and sixth month after operation were significantly lower than those of the common stent group[(0.68±0.12)points vs.(2.33±0.32)points,t=26.20,P<0.001;(0.82±0.22)points vs.(2.67±0.24)points,t=36.92,P<0.001].In the third month after operation,the restenosis rate of the radioactive particle stent group was significantly lower than that of the common stent group[5.88%(2/34)vs.42.4%(28/66),χ^(2)=14.27,P<0.001].The scores of QLQ-C30 and OES-18 scales in the first,second,third and sixth month after operation were lower than those before operation(all P<0.05).The scores of QLQ-30 scale in the radioactive particle stent group in the second,third and sixth month were significantly lower than those in the common stent group[(19.12±3.02)points vs.(21.22±2.87)points,t=3.39,P=0.001;(15.04±1.68)points vs.(20.43±2.23)points,t=12.39,P<0.001;(14.38±2.18)points vs.(19.77±3.67)points,t=9.20,P<0.001].The scores of OES-18 scale in the radioactive particle stent group were also significantly lower than those in the common stent group[(17.13±2.07)points vs.(20.64±2.11)points,t=7.95,P<0.001;(15.22±1.88)points vs.(19.24±1.76)points,t=10.62,P<0.001;(14.74±2.36)points vs.(18.53±3.27)points,t=6.01,P<0.001].Conclusion The radioactive particle stent can improve the quality of life of patients with advanced esophageal cancer with esophageal stenosis,so as to improve dysphagia and reduce the restenosis rate after operation.However,whether it is obviously superior to common stent in prolonging survival time and reducing complications needs to be further confirmed by a multicenter,prospective,large-sample randomized controlled study.