全覆膜镍钛记忆合金支架带外挂线及保护管对老年晚期食管贲门癌患者生存质量的改善作用  

Role of fully covered nickel-titanium memory alloy stent with external hanging thread and protective tube in improving quality of life in elderly patients with advanced carcinoma of esophagus and cardia

作　　者：徐法贞 黄曙 XU Fazhen;HUANG Shu(Department of Gastroenterology,Lianshui County People′s Hospital of Jiangsu Province,Lianshui People′s Hospital Affiliated to Kangda College of Nanjing Medical University,Huai′an,Jiangsu,223400)

机构地区：[1]江苏省涟水县人民医院/南京医科大学康达学院附属涟水人民医院消化科,江苏淮安223400

出　　处：《实用临床医药杂志》2022年第22期98-102,共5页Journal of Clinical Medicine in Practice

基　　金：江苏省双创计划项目(苏人才办〔2017〕37号文件);江苏省青年医学重点人才培养项目(QNRC2016442)。

摘　　要：目的观察全覆膜镍钛记忆合金食管支架带外挂线及保护管对老年晚期食管贲门癌患者生存质量的改善作用。方法将68例食管贲门癌伴管腔狭窄的老年患者随机分为对照组与观察组,每组34例。观察组在对照组基础上采用外挂线及保护管固定。术后随访支架在位情况,同时对支架置入前及置入后1个月吞咽困难分级进行评分;应用主观整体营养状况评价量表(PG-SAG)、人体测量和实验室检查等方法进行营养状况评价;采用卡氏功能状态评分标准(KPS)及9条目病人健康问卷抑郁量表(PHQ-9)评价患者生活质量和情绪状态。结果68例患者支架均一次性放置成功,成功率为100%。支架置入1个月后,对照组有5例发生支架移位,观察组未发生支架移位。对照组与观察组治疗前吞咽困难评分分别为(3.18±0.89)、(3.20±0.92)分,分别高于支架置入1个月后的(1.69±0.91)、(1.70±0.82)分,差异有统计学意义(P<0.01)。对照组与观察组治疗前PG-SGA评分分别为(2.81±0.67)、(2.74±0.54)分,分别高于支架置入1个月后的(1.21±0.73)、(1.20±0.93)分,差异有统计学意义(P<0.01)。实验室检查及人体测量方法的检查结果提示,患者治疗后的营养状况相关指标均改善。对照组与观察组治疗前KPS平均评分分别为(69.77±11.23)、(70.23±12.11)分,分别高于支架置入1个月后的(58.84±7.95)、(59.12±7.63)分,差异有统计学意义(P<0.01)。对照组与观察组治疗前PHQ-9评分分别为(14.04±4.73)、(13.98±4.86)分,分别高于支架置入1个月后的(8.06±1.09)、(7.97±1.17)分,差异有统计学意义(P<0.01)。结论全覆膜镍钛记忆合金食管支架置入是晚期食管贲门癌姑息治疗的有效方法,可改善患者的吞咽困难和营养状况,提高生活质量。加用外挂线固定可避免支架移位发生,加用保护管可减轻外挂线的切割损伤。Objective To observe the role of fully covered nickel-titanium memory alloy stent with external hanging thread and protective tube in improving quality of life in elderly patients with advanced carcinoma of esophagus and cardia.Methods A total of 68 elderly patients with carcinoma of esophagus and cardia complicated with lumen stenosis were randomly divided into control group and observation group,with 34 cases in each group.The observation group was treated with external hanging thread and protective tubes for fixation on the basis of the control group.The condition of the stent in position was followed up after operation,and classification of dysphagia was scored before and a month after the stent implantation;the nutritional status was evaluated by the Patient-Generated Subjective Global Assessment(PG-SGA),anthropometry and laboratory examination;the quality of life and emotional status of the patients were evaluated by the Karnofsky Performance Status(KPS)and the Patient Health Questionnaire-9 items(PHQ-9).Results The stents of 68 patients were placed successfully at one time,with a success rate of 100%.After one month of stent placement,there were5 cases with stent displacement in the control group,but no stent displacement was observed in the observation group.Before treatment,the scores of dysphagia in the control group and the observation group were(3.18±0.89)and(3.20±0.92)respectively,which were significantly higher than(1.69±0.91)and(1.70±0.82)respectively at one month after stent implantation(P<0.01).Before treatment,the scores of PG-SGA in the control group and the observation group were(2.81±0.67)and(2.74±0.54)respectively,which were separately higher than(1.21±0.73)and(1.20±0.93)respectively at one month after stent implantation(P<0.01).The results of laboratory examination and anthropometry revealed that the nutritional status of patients was improved after treatment.Before treatment,the scores of KPS in the control group and the observation group were(69.77±11.23)and(70.23±12.11)respecti

关 键 词：全覆膜镍钛记忆合金支架 保护管 食管贲门癌 吞咽困难 营养状况 生活质量 抑郁 

分 类 号：R817.5[医药卫生—影像医学与核医学] R816.96[医药卫生—放射医学]