癌性食管狭窄采用自膨式带膜食道支架置入的疗效影响因素分析  

The Factors Influencing the Efficacy of Self-expanding Covered Stents in the Treatment of Esophageal Stenosis

作　　者：张琪[1] 

机构地区：[1]四川省巴中市中心医院外三科,巴中636000

出　　处：《中国现代手术学杂志》2016年第1期34-37,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的研究分析癌性食管狭窄患者采用自膨式带膜食道支架置入的预后情况及影响因素。方法选择2010年1月至2013年1月入我院接受治疗的98例食管癌性狭窄患者进行回顾性研究分析。将不同规格的自膨式带膜食道支架置入患者癌性食管狭窄处,帮助患者扩张食道,并于术后对患者进行为期2年的随访,统计患者3个月、半年、1年、2年时的生存情况,并对8项可能影响患者生存率的因素进行单因素和多因素分析。结果所有患者均顺利完成手术,术后的食管狭窄段直径明显大于术前,差异有统计学意义(P<0.05)。手术前后,患者的吞咽状况比较存在显著差异(P<0.05),吞咽功能得到显著改善。从为期两年的随访结果来看,术后3个月、半年、1年、2年的生存率分别为:100%、88.78%、66.33%、46.94%,性别、年龄、食管的病灶部位、肿瘤细胞的分化程度以及置入支架后有无化疗对患者的生存率影响较小,无统计学意义(P>0.05);而肿瘤的UICC分期、有无合并瘘、根治手术史对生存率影响较大,均具有统计学意义(P<0.05)。并发症方面,术后胸骨后疼痛、食管异物感患者35例(35.71%),胃食管反流患者29例(29.59%),发热10例(10.20%),出血13例(13.27%),黑便11例(11.22%),经对症治疗后均有所好转。结论食管狭窄患者行自膨式带膜食道支架置入手术后的短期疗效显著,能有效扩张食管狭窄段直径,患者的吞咽功能得到显著改善,术后并发症均在可控范围内。而对患者预后造成影响的主要因素为肿瘤的UICC分期、有无合并瘘、根治手术史等。Objective To analyze the prognosis and factors influencing efficacy of self-expanding covered stents in the treatment of esophageal stenosis. Methods From January 2010 to January 2013,98 patients with esophageal cancer treated in our hospital were researched retrospectively. The different size of selfexpanding covered stents were used in esophageal stenosis patients. After operation,the patients were followed up for 2 years,and the survival rates were analyzed after 3 months,six months,1 year and 2 years. And 8 factors that might affect the survival rate were studied by univariate analysis and multivariate logistic regression analysis. Results All operations were successfully completed. The postoperative esophageal stenosis diameter was significantly larger than that before surgery（ P〈0. 05）. And the swallowing function improved significantly after operation（ P〈0. 05）. According to the follow-up results for a period of two years,the 3-month,6-month,1-year and 2-year survival rate was 100%,88. 78%,66. 33% and 46. 94% respectively. The gender,age,esophageal lesions,tumor cell differentiation and chemotherapy had no statistical significance to the 2-year survival rate（ P〉0. 05）. And the tumor UICC stage,fistula and radical surgery had statistical significances（ P〈0. 05）.In complications,there were 35 cases of postoperative chest pain and esophageal sensation（ 35. 71%）,29 cases of gastroesophageal reflux（ 29. 59%）,10 cases of fever（ 10. 20%）,13 cases of bleeding（ 13. 27%） and 11 cases of melena（ 11. 22%）. Conclusion The short-term effect of esophageal stenosis by self-expanding covered esophageal stents is great,which can effectively dilate the stricture diameter,and improve swallowing function. The main factors which influence the prognosis of patients are tumor UICC stage,fistula and radical surgery history.

关 键 词：食管肿瘤 食管狭窄 支架 

分 类 号：R735.1[医药卫生—肿瘤]