覆膜支架联合介入化疗治疗恶性食管气管瘘的对照研究  

Covered expandable metallic stent placement combined with interventional chemotherapy for malignant esophago-tracheal fistulae: a randomized comparison study

作　　者：严烁[1] 曹燕[1] 姜昊声[1] 方世明[1] 吴绍秋[1] 蒋霆辉[1] 茅爱武[1] 

机构地区：[1]上海交通大学医学院附属同仁医院介入科,200050

出　　处：《介入放射学杂志》2015年第4期323-327,共5页Journal of Interventional Radiology

基　　金：上海市卫生局青年课题(2010Y023)

摘　　要：目的探讨覆膜支架置入联合介入化疗治疗恶性食管气管瘘的安全性和疗效,并与单纯支架置入治疗比较。方法选择食管癌合并食管气管瘘60例患者行内支架置入联合介入化疗或单纯内支架置入治疗。60例患者随机分为支架组(A组)28例、支架联合介入化疗组(B组)32例,定期随访观察两组的近、远期疗效,并对有效率、中位生存时间、并发症进行统计分析。结果 60例患者中,58例支架置入堵瘘成功,成功率96.7%。A组中位生存时间为3.6个月,B组为8.7个月,两组差异有统计学意义(P<0.05)。B组1、3、6个月时的有效率分别为78.1%、68.8%、62.5%。并发症中食管支架再狭窄率,B组低于A组。结论内支架置入联合介入化疗能提高恶性食管气管瘘患者的中位生存期,并减少了支架带来的并发症,是一种安全、有效的治疗方法。Objective To evaluate the safety and therapeutic effect of covered expandable metallic stent placement combined with interventional chemotherapy in treating malignant esophago- tracheal fistulae.Methods A total of 60 patients with esophago- tracheal fistula were enrolled in this study. The patients were randomly divided into control group（n =28） and study group（n =32）. Patients of the control group were treated with covered stent implantation only, while patients of the study group were treated with combination use of covered stent implantation and interventional chemotherapy. All the patients were followed up regularly, the short- term and long- term results were determined, and the effect rate, median survival time and complications were statistically analyzed. Results Among the 60 patients, successful obstruction of the fistula was obtained in 58 with a success rate of 96.7%. The median survival time of the 58 patients was 5.8months. The median survival time of the control group and the study group was 3.6 months and 8.7 months respectively, the difference between the two groups was statistically significant（P〈0.05）. The one- month, 3-month and 6- month effect rates were 78.1%, 68.8% and 62.5% respectively. The incidence of esophageal stent re- stenosis in the study group was much lower than that in the control group. Conclusion The combination use of covered stent implantation and interventional chemotherapy can effectively improve the median survival time of patients with malignant esophago- tracheal fistula, and reduce the occurrence of stentrelated complications. Therefore, covered expandable metallic stent placement combined with interventional chemotherapy is an effective and safe treatment for malignant esophago- tracheal fistulae.

关 键 词：食管癌 恶性食管气管瘘 支架 动脉插管灌注化疗 

分 类 号：R735.1[医药卫生—肿瘤]