不同支架治疗晚期食管癌患者的疗效观察  

Observation on the efficacy of different stents in the treatment of patients with advanced esophageal cancer

作　　者：冀世玉 张明鑫 谢华红 白渊 王彤[4] Ji Shiyu;Zhang Mingxin;Xie Huahong;Bai Yuan;Wang Tong(Department of Gastroenterology,Jingbian County People's Hospital of Shaanxi Province,Yulin 718500,China;Department of Gastroenterology,the First Affiliated Hospital of Xi'an Medical University,Xi'an 710077;Department of Gastroenterology,Xijing Hospital of Digestive Diseases,Air Force Medical University,Xi'an 710032,China;Department of Pharmacy,the First Hospital of Yulin of Shaanxi Province,Yulin 719000,China)

机构地区：[1]陕西省靖边县人民医院消化内科,榆林718500 [2]西安医学院第一附属医院消化内科,西安710077 [3]空军军医大学西京消化病医院消化内科,西安710032 [4]陕西省榆林市第一医院药学部,榆林719000

出　　处：《国际肿瘤学杂志》2023年第2期76-81,共6页Journal of International Oncology

基　　金：陕西省重点研发计划(2021SF-129);2021年度浙江省消化系肿瘤微创诊治与快速康复研究重点实验室开放课题资助项目(21SZDSYS16)。

摘　　要：目的探讨内镜下普通支架植入与放射性125I粒子支架植入治疗晚期食管癌的疗效与安全性。方法回顾性分析2014年12月至2020年12月陕西省靖边县人民医院、西安医学院第一附属医院、空军军医大学西京消化病医院、陕西省榆林市第一医院收治的晚期食管癌患者的临床资料,根据植入支架类型的不同分为普通支架组(n=66)和放射性粒子支架组(n=34)。比较两组患者术后并发症、Karnofsky功能状态(KPS)评分、吞咽困难评分、再狭窄发生率及生命质量。结果普通支架组和放射性粒子支架组患者术后胸骨后疼痛发生率分别为65.2%(43/66)和47.1%(16/34),咽部疼痛、声音嘶哑发生率分别为12.1%(8/66)和5.9%(2/34),腹痛发生率分别为9.1%(6/66)和2.9%(1/34),渗血发生率分别为3.0%(2/66)和2.9%(1/34),恶心、呕吐发生率分别为7.6%(5/66)和5.9%(2/34),差异均无统计学意义(χ^(2)=3.04,P=0.081;χ^(2)=0.40,P=0.527;χ^(2)=0.53,P=0.467;χ^(2)<0.01,P>0.999;χ^(2)<0.01,P>0.999)。两组患者术后1、2、3、6个月的KPS评分均高于术前(均P<0.05);放射性粒子支架组术后2、3、6个月的KPS评分均显著高于普通支架组[(89.73±7.84)分比(82.37±7.42)分,t=4.62,P<0.001;(93.63±8.13)分比(88.33±7.28)分,t=3.74,P<0.001;(92.78±6.26)分比(87.28±8.73)分,t=3.77,P<0.001]。两组患者术后1、2、3、6个月的吞咽困难评分均低于术前(均P<0.05);放射性粒子支架组术后第3、6个月吞咽困难评分均显著低于普通支架组[(0.68±0.12)分比(2.33±0.32)分,t=26.20,P<0.001;(0.82±0.22)分比(2.67±0.24)分,t=36.92,P<0.001]。术后3个月放射性粒子支架组再狭窄发生率显著低于普通支架组[5.88%(2/34)比42.4%(28/66),χ^(2)=14.27,P<0.001]。两组患者术后1、2、3、6个月QLQ-C30和OES-18量表得分均低于术前(均P<0.05);放射性粒子支架组患者术后2、3、6个月的QLQ-C30量表得分显著低于普通支架组[(19.12±3.02)分比(21.22±2.87)分,t=3.39,P=0.001;(15.04±1.68)分�Objective To explore the efficacy and safety of treating advanced esophageal cancer by implanting the common stent and the radioactive 125I particle stent with endoscope.Methods The clinical data of patients with advanced esophageal cancer admitted to Jingbian County People's Hospital of Shaanxi Province,the First Affiliated Hospital of Xi'an Medical University,Xijing Hospital of Digestive Diseases of Air Force Medical University and the First Hospital of Yulin of Shaanxi Province from December 2014 to December 2020 were retrospectively analyzed.Patients were divided into common stent group(n=66)and radioactive particle stent group(n=34)according to different stent types.The postoperative complications,Karnofsky performance status(KPS)score,dysphagia score,restenosis rate and quality of life were compared between the two groups.Results The incidences of postoperative retrosternal pain in the common stent group and the radioactive particle stent group were 65.2%(43/66)and 47.1%(16/34)respectively.The incidences of pharyngeal pain and hoarseness were 12.1%(8/66)and 5.9%(2/34).The incidences of abdominal pain were 9.1%(6/66)and 2.9%(1/34).The incidences of errhysis were 3.0%(2/66)and 2.9%(1/34).The incidences of vomiting and nausea were 7.6%(5/66)and 5.9%(2/34)respectively.There were no statistically significant differences between the two groups(χ^(2)=3.04,P=0.081;χ^(2)=0.40,P=0.527;χ^(2)=0.53,P=0.467;χ^(2)<0.01,P>0.999;χ^(2)<0.01,P>0.999).In the two groups,KPS scores in the first,second,third and sixth month after operation were higher than those before operation(all P<0.05).KPS scores of the radioactive particle stent group in the second,third and sixth month were significantly higher than those of the common stent group[(89.73±7.84)points vs.(82.37±7.42)points,t=4.62,P<0.001;(93.63±8.13)points vs.(88.33±7.28)points,t=3.74,P<0.001;(92.78±6.26)points vs.(87.28±8.73)points,t=3.77,P<0.001].The dysphagia scores of patients in the two groups in the first,second,third and sixth month were lower than those be

关 键 词：食管肿瘤 内镜治疗 金属支架 放射性粒子支架 

分 类 号：R735.1[医药卫生—肿瘤]