经皮内镜下胃造瘘术在进展期鼻咽癌中的应用  

The use of percutaneous endoscopic gastrostomy in advanced nasopharyngeal carcinoma

作　　者：许昀[1] 林锦[1] 韩露[1] 郭巧娟[1] 张伟[1] 黄贺[1] 李睿[1] 林少俊[1] 潘建基[1] 

机构地区：[1]福建医科大学教学医院,福建省肿瘤医院放疗科,福州350014

出　　处：《中国癌症杂志》2013年第12期989-994,共6页China Oncology

基　　金：福建省卫生厅临床重点专科项目(2012);福建省自然科学基金(C0310034)

摘　　要：背景与目的：鼻咽癌好发于我国南方地区，同步放化疗在进展期鼻咽癌中的疗效显著，但同步放化疗的不良反应较单纯放疗显著增加，影响了患者放化疗的顺利进行。目前临床上常用局部对症处理和全身营养支持治疗等方法减轻放疗反应以提高患者治疗耐受性，但收效甚微。本文旨在探讨经皮内镜下胃造瘘术（percutaneous endoscopic gastrostomy，PEG）在进展期鼻咽癌中的应用价值。方法：福建省肿瘤医院2010年10月--2012年6月7l例病理证实的初诊鼻咽癌进展期患者，放化疗前行PEG术，放化疗期间行胃造瘘饮食及相关护理，检测放化疗不良反应、治疗耐受性及体重、血清白蛋白等营养指标情况。结果：71例患者行PEG术68例成功，3例失败。剩下的64例患者中51例顺利完成3周方案的同步化疗，同步化疗完成率为79．69％，4例因肝转移或肝功能损害未行同步化疗。所有68例患者体重变化在一11．86％～0．83％内，平均一5．32％±2．99％，前后血清白蛋白配对t检验提示放化疗前后差异无统计学意义（P=O．742）。60．29％（41／68）患者发生II度放射性口腔炎，22．06％（15／68）患者发生III度放射性口腔炎。结论：对初诊进展期鼻咽癌患者行预防性PEG术提高了患者同步放化疗的耐受性，降低了不良反应，减少了因放化疗不良反应引起的放疗中断时间，提高了同步化疗的完成率，改善了患者的营养状况及生存质量，且简单、经济、易行、安全。Background and purpose： Nasopharyngeal carcinoma usually occurs in people of states of the Southern China. Chemoradiotherapy plays an important role in the therapy of advanced nasopharyngeal carcinoma. However, chemoradiotherapy causes more toxic side effects than radiation therapy alone, which affects the therapy. Now symptomatic treatment and nutrition supports are common ways in the clinic in order to improve the tolerance of patients for the therapy, but with little effect. To evaluate the clinical significance of percutaneous endoscopic gastrostomy （PEG） in advanced nasopharyngeal carcinoma. Methods： From Oct. 2010 to Jun. 2012, a total of 71 patients with advanced nasopharyngeal carcinoma who received PEG before chemoradiotherapy were enrolled. During chemoradiotherapy, gastrostomy diet and nursing were supplied, adverse events, tolerance and nutrition indicators including weight and alcohol of human albumin were detected as well. Results： PEG were performed successfully on 68 patients, but failed in the other 3 patients. Of the 68 patients, 4 have not received concurrent chemotherapy because of liver metastases and liver function damage, 51 of the remaining 64 patients could completely finished 3 cycles of concurrent chemotherapy, with the completion rate of concurrent chemotherapy at 79.69%. The weight change ranged from -11.86% to 0.83%, with a mean value of-5.32%=2.99%. Paired-sample t test of human albumin before and after the treatment showed no significant difference （P=-0.742）. Grade II radioactive oral cavity mucositis appeared in 60.29% patients （41/68）, and 22.06% patients （15/68） suffered rade HI radioactive oral cavity rnneoiti ＇nnelnQinn.For patients with advanced nasopharyngeal carcinoma, preventative PEG improved the tolerance of chemoradiotherapy, reduce the incidence of adverse events. The period of therapy interruption caused by sever adverse event were shortened as well, PEG also increased the completion rate of concurrent chemotherapy. Nutritional status and livi

关 键 词：经皮内镜下胃造瘘术 鼻咽癌 同步放化疗 

分 类 号：R739.63[医药卫生—肿瘤]