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病人与方法 研究对象包括36例不宜手术的食道或贲门癌病人,男27例,女9例,年龄41～90岁(平均69岁),活检证实鳞癌32例,腺癌4例,狭窄长度2～14cm.吞咽困难的程度分为0～4级(0级吞咽正常,1级吞咽固体食物偶有困难,2级能吞咽半固体食物,3级仅能吞咽流质,4级不能吞咽唾液).病人治疗前的吞咽困难程度分别是1级1例,2级16例,3级12例,4级7例(平均2.7级).术前给予安定和哌替啶,若内镜插入困难可先在X线观察下,经导丝引导Savary-Gillard扩张器扩张食道,然后用硬化疗法注射针在肿瘤凸出的多个部位分别注入无水酒精0.5～1ml,注射总量取决于肿瘤大小.治疗后病人禁食4小时,若无并发症出现,术后当晚进食流质,次晨即可进软食.3～5天后,内镜下可见肿瘤坏死,每2周重复注射1次,直到内镜可顺利通过为止.结果 每次注入酒精总量1.5～2.5ml(平均7.8ml).14名病人注射1次,7名病人2次,4名病人3次,1名病人4次,平均1.8次.29 例病人吞咽困难级数至少改善1级,7例无效.病人的吞咽困难平均级数由治疗前的2.7级改善为1.4级(P<0.001).注射后12～24小时可有胸骨后疼痛及低热,1例病人并发纵隔炎,2例并发气管食管瘘,注射后吞咽困难复发间隔时间4～111天(平均
Patients and Methods Subjects Including 36 patients with esophageal or cardiac cancers that were not suitable for surgery, 27 males and 9 females, aged 41 to 90 years (mean 69 years). Biopsy confirmed 32 cases of squamous cell carcinoma, 4 cases of adenocarcinoma, narrow length 2 to 14cm. The degree of dysphagia is classified into 0 to 4 (0 swallowing is normal, 1 has difficulty swallowing solid foods, 2 can swallow semi-solid foods, 3 can only swallow liquids, and 4 can’t swallow saliva) The degree of dysphagia before treatment was 1 in 1 patient, 2 in 16 patients, 3 in 12 patients, and 4 patients in 7 patients (mean 2.7). Preoperative administration of diazepam and pethidine could be performed if endoscope insertion is difficult. Under the X-ray observation, the guide wire guides the Savary-Gillard dilator to dilate the esophagus, and then the sclerotherapy needle is used to inject 0.5 to 1 ml of anhydrous ethanol into various parts of the tumor. The total injection volume depends on the size of the tumor. After treatment, the patient was fasted for 4 hours. If no complications occurred, fluids were eaten on the night after the operation and the soft food was available in the next morning. After 3 to 5 days, tumor necrosis was seen under endoscopy. The injection was repeated every 2 weeks until endoscopy. Can be successfully passed until the results of each injection of alcohol total 1.5 ~ 2.5ml (average 7.8ml). 14 patients injected once, 7 patients 2 times, 4 patients 3 times 1 patient 4 times, an average of 1.8 times. 29 cases of patients with dysphagia at least to improve the level 1, 7 cases were invalid. The patient’s dysphagia, the average progression from 2.7 before treatment to 1.4 (P <0.001). 12 to 24 hours after injection, there may be post-sternal pain and hypothermia, 1 patient complicated with mediastinitis, 2 cases complicated with trachea and esophageal fistula, and the relapse interval after swallowing was 4 to 111 days (average