论文部分内容阅读
The esophageal stent has been demonstrated to serve as a safe and effective palliative treatment for advanced inoperable esophageal carcinoma. However,the safety of esophageal stents in patients with prior radiotherapy (RT) remains debated . This article aims to investigate the impact of prior RT on the incidence of fatal complications after self-expandable metallic stents (SEMS) for palliation of malignant dysphagia due to esophageal carcinoma.Between January 2007 and July 2010, 93 patients with malignant dysphagia due to esophageal carcinoma underwent placement of self-expandable metallic stents (SEMS) in our hospital. Patients were retrospectively separated into two groups: patients with RT before stent placement (RT group, n=58) and patients with no treatment before stent placement (no RT group,n=35).The median survival after stent placement was 77days (7-842 days) in RT group and 246days(15~878 days) in no RT group. Improvement in dysphagia score was similar in both groups. The fatal complications included fatal gastrointestinal hemorrhage and uncontrolled pneumonia. Logistic regression analysis showed a significant interaction between prior RT and fatal gastrointestinal hemorrhage (relative risk (RR) 7.68, 95％ CI 1.51~38.95;P=0.014). Mortality of massive hemorrhage was 0(0/4), 13%(3/24), 43% (13/30) respectively in patients who received <50Gy,50Gy~60Gy,>60Gy (x2=16.91; P=0.001). Logistic regression analysis disclosed a significant association between mortalities from uncontrolled pneumonia and esophageal fistula (RR13.27,95%CI 3.58~49.21;P=0.000) and lesion site (RR 0.17,95%CI 0.04-0.69; P=0.013). Mortality of uncontrolled pneumonia of both groups after stentplacement was similar(RR1.46,95% CI 0.21-10.05; P=0.698) . Mortality of uncontrolled pneumonia was 48% (13/27) in patients with esophageal fistulas versus 9%(6/66) without esophageal fistulas(x2=17.98; P=0.000).