内镜直视与X线透视下支架置入术治疗晚期食管贲门癌临床疗效比较  

Clinical efficacy comparison of endoscopic and X-ray placement of stenting in treatment of advanced esophageal and cardiac cancer

作　　者：王国义[1] 梁剑峰[2] 田锦林[3] 鲍峰[4] WANG Guoyi;LIANG Jianfeng;TIAN Jinlin(Department of General Surgery,Jiange People＇s Hospital,G uangyuan,Sichuan,Guangyuan 628300,China)

机构地区：[1]四川省剑阁县人民医院普外科,628300 [2]四川省剑阁县人民医院胃镜室,628300 [3]四川省剑阁县人民医院肿瘤科,628300 [4]四川省绵阳市中心医院普外科

出　　处：《临床外科杂志》2018年第9期679-682,共4页Journal of Clinical Surgery

摘　　要：目的探讨内镜直视与X线透视下支架置入术治疗晚期食管贲门癌病人的可行性及安全性。方法行支架置入术治疗的晚期食管贲门癌病人80例,按照随机数字表法将其分为治疗组与对照组两组,每组40例。治疗组给予内镜直视下支架置入术治疗,对照组给予X线透视下支架置入术治疗,观察并比较两组临床疗效以及术后并发症发生情况。结果两组病人均为一次性置入支架,其中治疗组置入带膜支架29例,置入不带膜支架11例,对照组置入带膜支架32例,置入不带膜支架8例,两组病人置入支架成功率均为100%,且支架置入位置准确,膨胀良好,9例食管支气管瘘病人瘘口严密封堵。治疗后2周,治疗组总有效率为90. 00%,对照组为85. 00%,差异无统计学意义(P> 0. 05)。与治疗前比较,治疗后2周两组病人Stooler分级均明显改善,两组比较差异无统计学意义(P> 0. 05)。两组病人术后胸痛、出血发生率均为100%,经抑酸、止血处理后均在1周左右缓解。两组术后并发症发生率比较,差异无统计学意义(P> 0. 05)。结论内镜直视与X线透视下放置支架术治疗晚期食管贲门癌病人均有效,内镜直视下操作简单,放置准确,病人狭窄程度较大可考虑X线透视下操作。Objective To investigate the feasibility and safety of endoscopic and X-ray placement of stenting in treatment of advanced esophageal and cardiac cancer. Methods 80 patients with advanced esophageal and cardiac cancer who underwent esophageal stent were selected as study subjects.They were divided into treatment group and control group according to the random numbers table（ 40 in each）. The treatment group was given endoscopic stenting under direct vision,and the control group was given stenting under X-ray fluoroscopy. The clinical efficacy and postoperative complications were observed and compared between the two groups. Results The stents were placed once in both groups. 29 covered stents and 11 stentless stents were were stented in the treatment group. 32 stented stents and 8 stentless stents were placed in the control group. The success rate of stent placement in both groups was 100%,and the stent placement was accurate and with good expansion. 9 patients with esophageal bronchial spasm were tightly sealed. After 2 weeks of treatment,the total effective rate was 90. 00% in the treatment group and 85. 00% in the control group. The difference was not statistically significant（ P〉0. 05）. Compared with before treatment,the Scooler grading of the two groups was significantly improved after two weeks treatment. There was no significant difference between the two groups（ P〉0. 05）. The incidence of postoperative chest pain and hemorrhage was 100% in both groups,and after alleviation of acid and hemostasis,they all eased in about 1 week. There was no significant difference in the incidence of postoperative complications between the two groups（ P〉0. 05）. Conclusion Endoscopic visualization and esophageal stent under X-ray fluoroscopy are effective in the treatment of advanced esophageal and cardiac cancers. Endoscopy under direct vision is simple and accurate. A greater degree of stenosis may be considered X-ray fluoroscopy.

关 键 词：食管贲门癌 晚期 食管支架术 内镜 X线 

分 类 号：R735[医药卫生—肿瘤]