食管内照射支架治疗食管癌的临床应用及随访观察

目的探讨采用携带125I粒子的内照射支架治疗食管癌的可行性并随访观察其疗效。方法采用内照射支架置入术治疗30例不可手术切除的食管癌患者,对患者住院期间及出院后的血液指标、影像学指标、并发症、吞咽困难指数及生存期进行观察,确定内照射支架的安全性及疗效。结果所有患者支架置入顺利,患者术前及术后的血象及免疫指标无统计学差异,影像学随访示125I粒子无脱落及放射性泄漏。20例术后3个月CT扫描示病变部位较术前变薄,8例于术后8个月CT结果示病变较前明显变薄。胸痛及消化道出血是常见并发症,未发生与内照射支架有关的食管穿孔及放射性肺炎。术后吞咽困难明显改善,胃镜提示再狭窄病例以肉芽组织增生为主,肿瘤过度生长少见。患者中位生存期为7个月,平均生存期为8.3个月。结论食管内照射支架临床应用安全有效,随访结果示其疗效确切、持久,有广泛的应用前景。

Esophageal intraluminal irradiation stent: clinical application and follow-up of treatment on esophageal cancer

Objective To investigate the feasibility of treatment on esophageal cancer with esophageal 125I seed irradiated stent and observe the clinical effectiveness. Methods Esophageal intraluminal irradiation stents were placed in 30 patients with inoperable esophageal cancer to know about the safety and effectiveness of the stents through the observation on hematological and radiological examination, complication, dysphagia score and life span during and after the hospital stay. Results Stent placement was successful in all patients. No significant difference was found in hemogram and immunity markers before and after surgery. The follow-up of radiology showed no 125I seed was lost and no radiation shed. 3 months follow-up by CT showed the target place was thinned in 20 cases, and 8 months follow-up showed obviously thinned in 8 cases. The most complications were chest pain and alimentary tract hemorrhage, and no complications were found including esophageal hemorrhage and radiation pneumonia related to irradiated stents. The rise of dysphagia score after surgery was obviously lower. Restenosis of the esophagus was mainly due to the growth of granulation tissue through the gastroscopy and biopsy. The mean survival time of the patients was 7 months and the median survival time was 8.3 months. Conclusion The clinical application of esophageal intraluminal irradiation stents is safe, effective, and the follow-up results show its effectiveness is exact, persistent, and having wide application perspective.