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作 者:郑文恒[1] 罗娅红[1] 于韬[1] 王颖[1] 李森[1] 魏宏[1] 赵莹[2] 李黎波[3]
机构地区:[1]辽宁省肿瘤医院医学影像科,沈阳市110042 [2]辽宁省肿瘤医院内镜科 [3]南方医科大学中西医结合医院肿瘤中心
出 处:《中国激光医学杂志》2014年第2期69-73,113,共6页Chinese Journal of Laser Medicine & Surgery
基 金:恶性肿瘤转化医学研究中心及协同研究网络建设基金(2013225021)
摘 要:目的应用数字减影血管造影(digital subtraction angiography,DSA)机器引导下的光动力联合球囊扩张术对食管、贲门癌性狭窄进行治疗,观察其安全性、可行性及疗效。方法经组织病理学证实为食管、贲门癌伴癌性狭窄的患者9例,先采用DSA引导下进行球囊扩张,然后通过胃镜结合DSA透视对病变位置进行定位,最后经过导管引入激光光纤覆盖病变区域进行光动力治疗;并在光动力治疗中应用DSA透视监测、调整光纤的位置。治疗后评价患者吞咽困难改善情况、肿瘤大小的变化及治疗后的相关并发症。结果所有病例治疗过程顺利,治疗后未出现相关并发症;患者吞咽困难明显缓解,吞咽困难等级评分由治疗前均数(3.33±0.7)到治疗后1个月(1.33±0.50),差异有显著意义(P<0.05);治疗后1个月复查胃镜显示:疗效SR为7例(占78.0%),MR为2例(占22.0%),显著有效率(CR+SR)为78.0%,总有效率(CR+SR+MR)为100.0%。结论食管、贲门癌伴癌性狭窄病例采用DSA引导光动力联合球囊扩张术的治疗方式安全,近期疗效明显。Objective To investigate the effect of photodynamic therapy and balloon dilation, guided by DSA, on malignant esophageal and esoph- agogastric ~tenosis. Methods Nine patients confirmed of esophagus and cardia cancer with esophagogastric stenosis with histopathology were included in the study. Firstly, the patients were given DSA-Guided balloon dilatation, and then the lesion proximal and distal position was confinned with gastroscope and DSA fluoroscopy. Finally, photodynamic therapy was conducted by introducing optical fiber to cover the lesion via a catheter. DSA fluoroscopy was applied to monitor and adjust the position of the optical fiber. All the patients were followed up for 1 month, and the improvement of dysphagia, changes of tumor size and complications associated were evaluated. Results All the patients were successfully treated, no complication being found during the treatment and follow-up. About 1 month after the treatment, the dysphagia score dropped significantly from (3.33 ± 0. 7 ) to ( 1.33 ± 0.5 ), ( P 〈 0. 05 ). The efficacy of treatment after 1 month was evaluated with endoscopy. SR was achieved in 7 cases (78% , 7/9) and MR in 2 cases (22% , 2/9). The significant effectiveness rate ( CR + SR) was 78% , and the total effectiveness ( CR + SR + MR) 100. 0%. Conclusions Photodynamie therapy combined with DSA-guided balloon dilation is effective and safe in treating malignant esophageal and eaophagogastric stenosis, and deserves further investigation.
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