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目的 :探讨影响中晚期食管癌支架治疗的因素。方法 :对 1996年 8月～ 2 0 0 0年 7月收住我科的 73例不可切除或拒绝手术治疗的中晚期食管癌合并严重狭窄患者 ,用Savary探条扩张器将狭窄部位扩张至 12 .8mm ,再经内镜观察 ,准确测定病变部位和长度 ,从而选择合适的支架 ,经引导钢丝置入自膨式支架。术后辅以内放疗或热疗。结果 :73例癌性狭窄患者中 ,42例术前未经外放射等任何治疗 ,术中支架均一次顺利成功置入 ,成功率为 10 0 % (4 2 /42 )。术后并发症少。而术前已行外放射治疗的 31例患者支架置入成功率为 2 9%(9/31) ,术后并发症发生率高 ,主要的并发症有 :术后大出血 ,持续严重胸痛 ,食管气管漏 ,支架扩张不良和支架移位再狭窄。已行外放射治疗组的支架置入成功率明显低于未放射组 (P <0 .0 1) ,且术后并发症发生率明显增高。结论 :外放射治疗明显降低食管癌患者支架置入的成功率 ,而增加术后并发症。建议对中晚期食管癌合并狭窄患者的治疗 ,可先行支架置入 ,以提高患者对放射治疗或热疗的敏感性与耐受性
Objective: To explore the factors that affect the treatment of advanced esophageal cancer. Methods: From August 1996 to July 2000, 73 cases of advanced esophageal cancer with severe stenosis who were unresectable or refused surgery in our department were enrolled. The patients were treated with Savary probe dilator to expand the stenosis to 12 .8mm, and then endoscopic observation, accurate determination of the lesion and length, so as to select the appropriate stent, the guide wire into the self-expanding stent. Postoperative radiotherapy or hyperthermia. Results: Of the 73 patients with cancer stenosis, 42 patients underwent preoperative radiotherapy without any treatment. The stents were successfully and successfully implanted in one time. The success rate was 100% (42/42). Postoperative complications less. The 31 cases who underwent external beam radiotherapy had a success rate of 29% (9/31), and the incidence of postoperative complications was high. The main complications were postoperative bleeding, persistent severe chest pain, esophagus Tracheal leakage, stent dilatation and stent restenosis. The success rate of stent placement in external radiotherapy group was significantly lower than that in non-radiotherapy group (P <0.01), and the incidence of postoperative complications was significantly higher. Conclusion: External beam radiotherapy can significantly reduce the success rate of stent implantation in patients with esophageal cancer, and increase the postoperative complications. Recommendations for the treatment of advanced esophageal cancer patients with stenosis, may be the first stent implantation to enhance the patient’s sensitivity to radiation therapy or hyperthermia and tolerance