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目的 探讨食管癌穿孔治疗的有效方法。方法 34例食管癌放疗后并发食管气管瘘、纵隔瘘病人 ,分别采用鼻饲营养、胃造瘘术、附膜编织网支架治疗 ,肿瘤复发病例加用放疗、化疗及其他综合治疗等方法。结果 6例应用鼻饲 (其中 1例加放疗使瘘愈合 ,生存 1年 3个月 )中位生存期 5 8个月。 15例胃造瘘中 ,5例行放疗 ,2例生存 1年以上。 5例无肿瘤患者造瘘后生存 1年以上 2例 ,2年以上 1例。 7例应用附膜编织网支架技术 ,3例健在。对症治疗和放弃拒绝治疗者无长期生存。结论 食管癌穿孔治疗首选胃造瘘为宜 ,它优于附膜编织网支架及鼻饲营养治疗。
Objective To explore effective methods for perforation of esophageal cancer. Methods Thirty-four patients with esophageal tracheospasm and mediastinal fistula who underwent esophageal cancer after radiotherapy were treated with nasal feeding, gastrostomy, and membrane-covered mesh stents. Radiotherapy, chemotherapy, and other comprehensive treatments were used for tumor recurrence. Results The median survival time was 5 8 months in 6 cases with nasal feeding (one of them was treated with radiotherapy to heal the tendon and survived for 1 year and 3 months). In 15 cases of gastric fistula, 5 cases received radiotherapy and 2 cases survived for more than 1 year. Five patients with tumor-free survival survived more than one year in 2 cases and more than 2 years in 1 case. 7 cases were treated with a braided mesh stent, and 3 cases were alive. Symptomatic treatment and renunciation of treatment do not have long-term survival. Conclusion Gastric fistula is the best choice for the perforation of esophageal cancer. It is superior to the stented mesh stent and nasal feeding nutrition therapy.