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中华胸部外科电子杂志 ›› 2018, Vol. 05 ›› Issue (03) : 168 -172. doi: 10.3877/cma.j.issn.2095-8773.2018.03.06

所属专题: 文献

论著

内镜联合X线监视下支架植入治疗中晚期食管癌恶性梗阻的临床应用
赵素清1, 杨海平1, 毛宇1,()   
  1. 1. 010030 呼和浩特市第一医院胸外科
  • 收稿日期:2017-12-14 出版日期:2018-08-28
  • 通信作者: 毛宇

Clinical application of stent implantation monitoring with endoscope and X-ray in the treatment of malignant obstruction of late esophageal carcinoma

Suqing Zhao1, Haiping Yang1, Yu Mao1,()   

  1. 1. Department of Thoracic Surgery, the First Hospital of Hohhot, Inner Mongolia, 010030 China
  • Received:2017-12-14 Published:2018-08-28
  • Corresponding author: Yu Mao
  • About author:
    Corresponding author: Mao Yu, Email:
引用本文:

赵素清, 杨海平, 毛宇. 内镜联合X线监视下支架植入治疗中晚期食管癌恶性梗阻的临床应用[J/OL]. 中华胸部外科电子杂志, 2018, 05(03): 168-172.

Suqing Zhao, Haiping Yang, Yu Mao. Clinical application of stent implantation monitoring with endoscope and X-ray in the treatment of malignant obstruction of late esophageal carcinoma[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2018, 05(03): 168-172.

目的

探讨内镜联合X线监视下支架植入治疗中晚期食管癌恶性梗阻的临床疗效。

方法

选择2010年6月—2017年10月在内蒙古呼和浩特市第一医院中晚期食管癌恶性梗阻的67例患者,根据患者意愿分为内镜联合X线监视下支架植入组(联合组,n=35)和X线监视下放置支架组(普通组,n=32)。观察比较两组患者术前及术后1~3个月的生活质量和吞咽困难指数变化情况,观察患者的术后并发症并及时对症治疗;统计术后患者的生存期与存活率,并采用生存质量核心问卷(QLQ-C30)和食管癌专用量表(OES-18)调查患者的生活质量。

结果

两组患者均一次性成功植入支架,成功率达100%,吞咽困难立刻改善明显,两组评分由联合组和普通组的(3.3 ±0.6)和(3.2 ±0.7)分改善为(1.0±03)分,1周后的评分均改善为0分。两组患者术中、术后无大出血和穿孔的发生,均有不同程度的胸骨后疼痛和不适,大多数均不需特殊处理。联合组患者的再阻塞率、生存时间、生存质量明显高于普通组患者(P<0.05),联合组的再阻塞率明显低于普通组患者(P<0.05);但两组间支架移位率无统计学差异(P>0.05)。

结论

应用内镜和X线双重定位下植入支架治疗不愿或不能手术切除的中晚期食管癌患者,具有创伤小、安全、定位准确等特点,能迅速缓解患者的症状,提高生存质量,延长生存时间,具有良好的临床应用价值。

Objective

To investigate the clinical efficacy of stent implantation monitoring with endoscope and X-ray in the treatment of malignant obstruction of late esophageal carcinoma.

Methods

From June 2010 to October 2017, 67 patients with malignant obstruction of late esophageal cancer in the First Hospital of Hohhot, Inner Mongolia, were divided into the joint group (n=35) who underwent stent implantation monitoring with endoscope and X-ray, and the normal group (n=32) who underwent stent implantation monitoring with only X-ray. The quality of life and dysphagia index of the two groups were compared before operation and 1 to 3 months after operation. The postoperative complications were observed and relevant treatments were performed. The lifetime and survival rates of the patients were counted. Quality of Life Questionnaire-Core (QLQ-C30) and Esophageal Cancer Special Scale (OES-18) were used to investigate the life quality of the patients.

Results

The stents were successfully implanted at the first time for the two groups with 100% success rate, and the dysphagia was immediately improved. The scores were improved from 3.3±0.6 and 3.2±0.7 points to 1.0±0.3 in the joint group and the normal group respectively. The scores after 1 week were improved to 0 point in the two groups. There were no major hemorrhages and perforations in the two groups during and after surgery. Both groups had varying degrees of retrosternal pain and discomfort, but most patients did not require special treatment. The survival time and life quality of the joint group were significantly better than those of the normal group (P<0.05), and the re-occlusion rate of the joint group was significantly lower than that of the normal group (P<0.05). There were no statistically differences in the stent relocation rate between the groups (P>0.05).

Conclusions

The application of stent implantation monitoring with endoscope and X-ray on the patients who suffer from late esophageal carcinoma and cannot undergo surgery has the advantages of small trauma, higher safety and accurate positioning, which can quickly relieve the symptoms, improve the life quality and prolong the survival time.

表1 联合组和普通组食管癌患者基线资料比较
表2 联合组和普通组食管癌患者技术指标比较(±s)
表3 联合组和普通组食管癌患者并发症发生情况比较[n(%)]
[1]
叶任高.内科学[M].北京:人民卫生出版社,2002:360-390.
[2]
徐丽芳,郑铨,吴断萍.胃镜直视下置放金属支架治疗食管狭窄及食管气管瘘56例临床观察[J].中国内镜杂志,1999,4 (l5)60-61.
[3]
张亚历.图解消化病学-临床经典诊断术治疗方法[M].北京:军事医学科学出版社,2003: 29-99.
[4]
李慧霞,杨华,郎文静. 量表EORTC QLQ-OES18在中国食管癌患者中的有效性验证[J].重庆医学,2016,20:2969-2972.
[5]
郑良成,田辉荣,谢培增. 医学生存质量评估[M]. 北京:军事医学科学出版社,2005:169-174.
[6]
李世清,杜宗汉,周晓晴,等.内镜下带膜金属支架治疗食管癌食管狭窄和食管气管瘘64例临床观察[J].黑龙江医学,2016,8(40)691-692.
[7]
张宝阳,姜昊声,刘诗义,等.内镜直视联合X线监视置入支架治疗胃十二指肠恶性梗阻47例[J].介入放射学杂,2009,10(18):763-765.
[8]
刘福贵,刘芳.内镜下支架植入术治疗进展期食管及贲门癌18例临床观察[J].医药论坛杂志,2011,9(32)180-181.
[9]
童乾纲,樊树峰,张家兴,等.自膨式带膜食管支架在恶性食管狭窄者中的应用[ J] .介入放射学杂志,2002,1(6):439-441.
[10]
Ferlay J, Shin HR, Bray F, et al. Estimates of world wideburden of cancer in 2008: GLOBOCAN 2008[J]. Int J Cancer, 2010,127(12):2893-2917.
[11]
Sreedharan A, Harris K, Crellin A, et al. Interventions for dysphagia in oesphageal cancer[J]. Cochrane Database Syst Rev, 2009 ,(4):CD005048.
[12]
Ferreira F, Bastos P, Ribeiro A, et al. A comparative study between fluoroscopic and endoscopic guidance in palliative esophageal stent placement[J]. Dis Esophagus, 2012,25(7):608-613.
[13]
张烁,吕宾,孟立娜,等.食管支架术后再狭窄的成因及处理[J]. 中华消化内镜杂志,2008,25( 3) : 154-155.
[14]
吴永梅,邱枫,戴晖,等.内镜直视下带膜支架置入联合氩气刀治疗晚期食管癌[J]. 中国内镜杂志,2009,24(10) : 1074-1077.
[15]
钟立明,魏欣,胡鸿,等.金属内支架治疗消化道恶性梗阻的方法探讨[J].中国介入影像与治疗学,2008,5(6):437-440.
[16]
刘正新.奈特消化系统疾病彩色图谱[M].北京:人民卫生出版社,2008:13-15,95-100.
[17]
Jeurnink SM, Repici A, Luiqiano C,et al. Use of a colonoscope for distal duodenal stent placement in patients with malignantobstruction[J]. Surg Endosc,2009,23(3): 562-567.
[18]
林含舜,曹美萍,李军苗,等.金属内支架植入治疗胃窦幽门恶性狭窄[J].介入放射学杂志,2005,14(1):79-80.
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