放射性125I粒子支架适形治疗中晚期食管癌

目的探讨放射性~(125)I粒子支架适形治疗中晚期食管癌的临床价值。方法回顾性分析在我院接受支架治疗的中晚期食管癌患者68例,根据患者是否自愿接受放射性~(125)I粒子分为两组:普通支架组30例,粒子支架组38例,根据放射治疗计划系统(TPS)及肿瘤形态适形综合布源放射性粒子。比较两组支架置入成功率、并发症发生率、吞咽困难改善率及生存期情况。结果两组支架置入成功率100%,均未发生严重并发症,吞咽困难均缓解,两组间吞咽困难改善情况比较差异无统计学意义(P0.05),但粒子支架组平均生存期及中位生存期明显长于普通支架组(P均0.05)。结论中晚期食管癌患者治疗中,根据TPS及肿瘤形态适形综合布源不同活度放射粒子支架安全、可靠,可有效延长患者生存期,值得临床广泛应用。     

带膜网状镍钛合金支架治疗恶性病变引起的食管狭窄

目的 通过使用带膜网状镍钛合金支架治疗恶性病变引起的食管狭窄,评价该支架的临床应用价值.方法 对38例食管狭窄患者行食管支架植入,其中晚期食管癌引起食管狭窄23例(1例上段食管癌合并食管-气管瘘),晚期贲门癌4例,食管、贲门癌术后吻合口复发6例,肺癌侵及食管4例,纵隔淋巴结转移癌压迫食管1例.全部病例均在X线电视监视下经口食管扩张后放入带膜网状镍钛合金支架,术后全身静脉化疗并进行随访.结果 本组无手术死亡.38例共进行39次支架植入,均一次性放置成功,其中1例因肿瘤生长超过原支架上缘引起再堵塞,而于首次支架植入2.5个月后第2次放置,1例15cm长食管癌患者同时放置2根支架.支架植入后静脉化疗(卡铂+5氟脲嘧啶,共4个疗程).随访观察35例,26例平均生存4.5个月后死亡;6例生存11～19个月,平均1 6个月;3例生存超过24个月.死前1～7 d均可进食,无严重并发症发生.结论 带膜网状镍钛合金支架治疗恶性病变引起的食管狭窄,可较好地改善患者的进食状况,提高生活质量.     

应用带膜镍钛记忆合金支架治疗晚期食管癌

目的总结应用带膜镍钛记忆合金支架治疗晚期食管癌的临床经验。方法53例晚期食管癌患者在食管X线钡餐透视下采用介入法、内镜法或术中植入法在食管内放置带膜镍钛记忆合金支架。术后进食困难程度用Neuhaus分级评估，并随访观察所有患者近期和远期疗效。结果所有患者支架均一次放置成功，无操作引起的严重并发症，术后患者吞咽困难症状明显改善，置入支架后患者吞咽困难分级较置入支架前明显降低（P〈0．01），能顺利进半流质或普通食物。狭窄食管段直径由2～4mm扩张至16～20mm。随访49例（92．5%），随访时间3～24个月。术后近期并发症主要为胸骨后异物感、疼痛、恶心和少量消化道出血，发生率为96．2％（51／5a）。26例患者（53．1％，26／49）于术后3～15个月内死亡，平均生存7．8个月，死亡原因多为肿瘤转移、全身衰竭。结论食管内放置带膜镍钛记忆合金支架治疗晚期食管癌患者的食管狭窄、食管瘘简单易行、损伤小，近期疗效明显，是一种有效的姑息性非手术治疗方法。     

胆道支架联合~(125)I粒子植入治疗恶性梗阻性黄疸临床效果分析

目的:分析胆道支架联合~(125)I粒子植入治疗恶性梗阻性黄疸临床效果。方法:将98例行经皮肝穿刺胆管引流术后要求行胆管支架植入术的恶性梗阻性黄疸患者分为联合组(n=53)和单纯组(n=45),联合组患者采取~(125)I粒子条联合胆道支架植入,单纯组患者仅接受胆管支架植入。所有患者随访4~28个月,记录两组患者经皮肝胆管引流术前及胆道支架植入术后7 d、30 d和90 d总胆红素变化;记录两组患者再次发生胆道梗阻情况;分别于经皮肝胆管引流术前、胆道支架植入术后7 d,检测患者外周血T淋巴细胞亚群变化;比较两组患者术后生存时间。结果:两组患者均顺利完成胆道支架植入,手术成功率100%,联合组患者支架植入术后30 d和90 d时血清总胆红素水平均显著低于单纯组,差异有统计学意义(P0.05);术后7 d时,联合组患者CD4水平和CD4/CD8比值均较术前升高,而单纯组患者CD4水平和CD4/CD8比值均较术前降低,差异有统计学意义(P0.05);与单纯组相比,联合组患者术后7 d时CD4水平和CD4/CD8比值均升高(P0.05);联合组中2例(3.8%)再次发生胆道梗阻,显著低于单纯组(37.8%),差异有统计学意义(P0.001);联合组中位生存时间10.6个月,显著长于单纯组(7.5个月),差异有统计学意义(P0.05)。结论:~(125)I粒子支架腔内照射治疗恶性梗阻性黄疸可缓解胆道梗阻症状,有助于改善患者细胞免疫功能,减少胆道梗阻的再次发生,对提高患者生存质量、延长生存时间具有重要意义。     

覆膜支架在中晚期食管癌的应用53例

目的评价覆膜支架应用于中晚期不能切除的食管癌性狭窄的姑息治疗效果。方法进食困难的中晚期食管癌患者53例(其中8例为食管气管瘘),在X线透视下进行支架置入治疗,并随访6个月～1年。结果53例全部成功置入了被覆金属支架,术后病人的进食状况明显改善,生活质量有不同程度提高。结论置入食管被覆支架治疗中晚期食管癌性梗阻是一种安全、有效的姑息性治疗方法。     

碘-125粒子支架植入治疗晚期食管癌

目的探讨附有放射碘-125（^125Ⅰ）粒子的机织式支架植入治疗晚期食管癌的效果,总结临床经验,以期为晚期食管癌患者的合理治疗提供临床依据。方法37例晚期食管癌患者应用附有^125Ⅰ粒子的机织式支架植入治疗,术中、术后观察随访支架植入成功率及并发症的发生率,比较术前与术后3个月食管病变长度和白细胞计数的变化。结果37例患者手术过程顺利,支架植入成功率均为100％,仅3例患者胸部有明显疼痛不适感,经对症处理后缓解;随访6个月,随访33例,失访2例,死亡1例,因年龄偏大,体质较弱死亡。术后3个月,吞咽困难缓解率为100％,治疗后较治疗前食管病变长度明显缩小（P〈0．05）,而白细胞计数的变化差异无统计学意义（P〉0．05）。结论附有^125Ⅰ粒子的机织式支架能明显改善吞咽困难症状,还可对肿瘤进行组织间放疗,明显改善患者术后的生存质量。     

手术切除联合术中125Ⅰ粒子组织间植入治疗食管癌的疗效分析

目的探讨手术切除联合术中125I粒子组织间植入治疗食管癌的疗效和副作用。方法回顾性分析2004年10月至2009年9月61例中、晚期食管癌患者(盐城市第五人民医院32例,南京医科大学附属南京第一医院29例)采用手术切除联合术中125I粒子组织间植入或联合放疗治疗的临床资料。根据治疗方法不同,将61例患者分为两组,125I粒子植入组:31例[男21例,女10例;年龄(59.5±1.5)岁],采用手术切除+术中125I粒子组织间植入治疗;对照组:30例[男19例,女11例;年龄(60.1±1.6)岁],术后3～4周采用体外放射治疗。观察两组患者术前、术后白细胞(WBC)、血小板(PLT)、免疫球蛋白的变化,比较生存率、复发率和转移率。结果术后1个月、3个月和5个月,两组患者外周血WBC、PLT和免疫球蛋白均在正常范围内;两组间比较差异无统计学意义(P>0.05)。两组患者均获随访,随访时间1～5年。术后6个月125I粒子植入组患者行胸部X线片检查示:均未发现粒子移位。125I粒子植入组患者1年、3年和5年生存率均明显高于对照组(3年58.3%vs.42.8%,P<0.05;5年36.8%vs.26.6%,P<0.05),复发率(3年0%vs.6.7%,P<0.05;5年3.2%vs.13.3%,P<0.05)和转移率(3年12.9%vs.20.0%,P<0.05;5年16.1%vs.33.3%,P<0.05)明显低于对照组。结论手术切除结合125I粒子组织间植入治疗食管癌,方法简单、使用安全、副作用小,可提高食管癌患者的生存率。     

内镜下行食管癌放射性125I粒子支架植入术的护理

目的:探讨内镜下行食管癌放射性125I粒子支架植入术的方法和护理.方法:我院5例食道癌患者在内镜下行食管癌放射性125I粒子支架植入术,采取防护措施后安装125I粒子入支架离子壳内.进镜观:距门齿34-38cm可见肿瘤环形腔内生长,狭窄段约4cm,进镜阻力较大,有接触性出血,于胃留置导丝退镜,沿导丝插入支架植入器,内镜直视下缓慢释放8.0cm×2.0cm支架一枚,上口完全开放,距门齿31cm,最上排粒子位于最狭窄处开放良好,退镜.结果:5例患者经内镜下行食管癌放射性125I粒子支架植入术后吞咽困难明显改善,未出现食道破裂穿孔、出血、感染、支架移位等并发症.结论:内镜下行放射性125I粒子支架植入是治疗食道癌患者的一种有效治疗方法.术前护理、术中配合以及术后的护理直接影响治疗效果.因此,做好内镜下放射粒子支架植入术的术前、术中、术后护理非常重要.     

术中联合125Ⅰ粒子植入治疗中晚期食管鳞状细胞癌前瞻性研究

目的 探讨术中联合125Ⅰ粒子植入治疗胸段中晚期食管鳞状细胞癌(ESCC)的安全性及疗效.方法 前瞻性队列研究,入组时间为2000年1月至2004年8月.298例Ⅱ～Ⅲ期胸段ESCC患者随机分为术中联合125Ⅰ粒子植入组(A组,150例)及单纯手术组(B组,148例).A组术中直视下植入125Ⅰ粒子,术后通过CT和胸部X线片行粒子验证和质量评估.所有患者根据术中情况行食管癌根治术、姑息减瘤术或食管胃转流术.临床观察患者术后并发症,CT监测肿瘤影像学和局部复发情况,按WHO相关肿瘤评定标准评价患者近期疗效,随访术后1、3、5和7年生存率.结果 随访截至2008年8月31日,中位随访42个月(95%CI:37～55个月).A组术后粒子验证无移位、脱落,质量评估满意.A组及B组局部复发率分别为14.9%、38.7%,差异有统计学意义(P<0.05).术后3个月,A组有效率78.8%,与B组30.3%比较差异有统计学意义(P<0.05).两组并发症差异无统计学意义(P>0.05).A组及B组的3、5和7年生存率分别为64.0%比52.0%、42.7%比34.5%、25.1%比12.6%,差异有统计学意义(P<0.05).结论 术中联合125Ⅰ粒子植入治疗中晚期ESCC是简单、安全、有效的方法,可降低局部复发率、延长患者生存期.     

单纯胆道支架与125I粒子支架腔内照射治疗恶性梗阻性黄疸

目的 探讨单纯胆道支架与支架联合125I粒子条植入腔内照射治疗恶性梗阻性黄疸的临床价值.方法 对62例恶性阻塞性黄疸患者行经皮经肝胆管引流(PTCD)后随机分组:A组31例行胆道支架联合125I粒子条植入(实验组),B组31例行单纯胆道支架植入(对照组).比较两组患者术前、术后黄疸消退、复发情况、T淋巴细胞亚群变化以及生存时间.结果 A、B两组患者PTCD术前及支架植入术后1周血清总胆红素测定差异无统计学意义(P＞0.05).术后1个月、3个月血清总胆红素测定,A组优于B组(P＜0.05).随访期内,A组再次发生胆道梗阻1例,B组12例(P＜0.05).对比PTCD术前,A组术后1～2周CD4及CD4/CD8比值明显升高(P＜0.05),CD3变化无差异(P＞0.05).B组术后1～2周CD3、CD4及CD4/CD8比值变化无明显差异(P＞0.05).A组患者中位生存时间10.9个月,B组患者中位生存时间7.1个月,两组差异有统计学意义(P＜0.05).结论 125I粒子条联合胆道支架植入腔内照射治疗恶性梗阻性黄疸在黄疸消退、改善机体免疫机能及延长患者生存时间等方面均优于单纯胆道支架植入治疗.     

The palliation of dysphagia secondary to esophageal-cardial carcinoma with self-expandable metal prostheses. The authors' personal experience with 92 patients]

BACKGROUND: Endoscopic insertion of a stent is an important option in the palliative management of esophageal obstruction and esophagorespiratory fistula. Plastic stents have been available for over 20 years. A new class of self-expanding metal stents for palliation of esophageal and cardial cancer is now available. METHODS: Between September 1992 and October 1997, 92 patients underwent implantation of self-expanding metal stents for palliation of dysphagia due to inoperable esophageal or cardial cancer (65 patients) or for locally recurrent carcinoma after surgery (12 patients), laser-therapy (11 patients) or radiotherapy (4 patients). RESULTS: Successful stent implantation was achieved in 89/92 patients (96.7%). After stent implantation the dysphagia score improved from 3.0, on average, to 0.5, on average. Early complications were observed in 4.5% and peroperative mortality was 2.1%. Late complications were observed in 25.6%, with a mortality rate of 1.1%. The mean survival time was 6.9 months. CONCLUSIONS: Self-expanding metal stents are a new effective alternative for palliation of dysphagia due to esophageal and cardial cancers.     

An antireflux stent versus conventional stents for palliation of distal esophageal or cardia cancer: a randomized clinical study

Background Self-expandable metal stents placed across the esophagogastric junction for palliative treatment of malignant strictures may lead to gastroesophageal reflux and pulmonary aspiration. This study compared the effects of a Dua antireflux stent with those of a conventional stent. Methods Patients with incurable cancer of the distal esophagus or gastric cardia were randomly assigned to receive an antireflux stent (n = 19) or a standard stent (n = 22) at nine Swedish hospitals during the period September 1, 2003 to July 31, 2005. Complications were recorded at clinical follow-up visits. Survival rates were assessed through linkage to the Population Register. Dysphagia, reflux symptoms, esophageal pain, dyspnea, and global quality of life were assessed as changes in mean scores between baseline and 1 month after stent insertion through validated questionnaires. Results No technical problems occurred during stent placement in the 41 enrolled patients. Fewer patients with complications were observed in the antireflux stent group (n = 3) than in the standard group (n = 8), but no statistically significant difference was shown (p = 0.14). The survival rates were similar in the two groups (p = 0.99; hazard ratio, 1.0; 95% confidence interval, 0.5–2.0). The groups did not differ significantly in terms of studied esophageal or respiratory symptoms or quality of life. Clinically relevant improvement in dysphagia occurred in both groups. Dyspnea decreased after antireflux stent insertion (mean score change, –11), and increased after insertion of standard stent (mean score change, +21). Conclusions Antireflux stents may be used without increased risk of complications, mortality, esophageal symptoms, or reduced global quality of life. These results should encourage large-scale randomized trials that can establish potentially beneficial effects of antireflux stents.     

镍钛记忆合金网状内支架治疗食管狭窄

目的食管腔内放置镍钛记忆合金网状内支架，持续扩张食管、贲门部狭窄，改善患者饮食通道。方法利用内支架置放器等器械在Ｘ线下行食管狭窄扩张后放入适当长度的内支架。术后及２天、１月摄Ｘ线片对照。结果２８例均放置成功。术后定期复查，内支架膨胀、固定良好，内径最窄处平均直径１．３ｃｍ。２６例术后吞咽困难即消失。术后死亡９例，平均存活７个月。结论该术式简便、痛苦小、并发症少，解除梗阻快，有效地提高了患者生存质量，延长了存活时间     

Prospective evaluation of a new self-expanding plastic stent for inoperable esophageal strictures

BACKGROUND: High stent cost is considered the major drawback of self-expanding metal stents for dysphagia palliation in patients with inoperable esophageal strictures. We report our experience with a self-expanding plastic (Polyflex) stent, the cost of which is half that of the metal stents. METHODS: Between September 1999 and April 2001, 16 dysphagic patients (15 men; mean age, 69.4 +/- 14.5 years; range, 49-100 years; mean dysphagia score, 3.31 +/- 0.6) with esophageal strictures who underwent Polyflex stent placement (insertion device diameter, 12-14 mm; postexpansion inner stent diameter, 16-21 mm; stent length, 9, 12, and 15 cm) were studied prospectively. The strictures were caused by postsurgical recurrence of gastric/esophageal cancer at the anastomotic site in five patients, primary esophageal cancer in four patients, esophagocardia junction cancer in four patients, metastatic mediastinal lymph nodes from a primary lung cancer invading the esophagus in 1 patient, and benign peptic stricture in two elderly patients. All the patients were prospectively followed until death. RESULTS: Stent insertion was technically successful in 12 patients (75%). Stent placement failed in four patients (25%) because of failure to pass the delivery catheter across the stricture in three patients and failure of the stent to open in one patient. Early and late stent migration occurred in two patients and 1 patient, respectively. Tumor overgrowth occurred in 1 patient. The mean dysphagia score 7 days after stent placement was 1.1 +/- 0.9. Mean survival was 100.6 +/- 71.2 days (range, 8-225 days). CONCLUSION: Self-expanding Polyflex stents are safe and effective for inoperable esophageal strictures and have an acceptable technical success rate. Further experience, better selection criteria, and design improvements should improve results.     

Complete fundoplication has similar long-term results in patients with and without esophageal body dysmotility

Background: Partial fundoplication is advocated for the treatment of gastroesophageal reflux disease in patients with poor esophageal body function. We hypothesized that a complete floppy wrap may be just as safe in patients with poor esophageal motility. Methods: A retrospective, case-control study was performed on patients who underwent a complete fundoplication and had poor esophageal motility. Study patients were matched with controls with normal esophageal body pressures according to sex, age, and duration of reflux symptoms. Patients were followed up and interviewed using a modified symptom and life quality questionnaire. Results: Twenty-two patients and 22 matched controls underwent a complete fundoplication. The mean esophageal body pressure was 42.1 and 87.5 mmHg in the study and control groups, respectively (p <0.05). Average time to resolution of dysphagia was 10.1 weeks in the study group and 12 weeks in the control group. All patients but 1 (control) graded their life quality improvement as good to excellent. Conclusion: Our data suggest that a 360° fundoplication has similar long-term results regardless of esophageal body motility. We suggest that a partial fundoplication may be reserved for patients with severe esophageal body dysfunction. The role of manometry in the preoperative workup should be reassesed: it may be mandatory only in patients with preoperative dysphagia or when achalasia is suspected.     

应用带膜支架治疗晚期食管癌贲门癌

目的　探讨置入国产CZES型自膨式带膜支架 ,结合其它疗法综合施治重症晚期食管癌贲门癌病人的疗效。方法　采用内镜法、介入法、混合法、手术法 ,为晚期食管癌、贲门癌、食管瘘、吻合口漏、吻合口癌复发或吻合口狭窄病人 15 1例 ,共置入 15 9个支架 ,继而 132例实施放、化疗和中药综合施治。结果　疗效满意 ,明显改善了病人生活质量 ,体质增强 ,进食困难分级由 3.12级降至 1.0 5级 ,肿瘤缩小 2 2～ 3 4cm ,体重增加 1～ 6kg ,置入支架后生存 1 5～ 36个月。结论　置入支架结合综合施治行之有效 ,操作简便、安全可靠 ,适用于临床 ,易于推广     

Use of the Polyflex stent in the palliative therapy ofesophageal carcinoma

BACKGROUND: Several prospective randomized trials have shown that self-expanding stents have advantages over conventional plastic tubes. Nevertheless, the optimal stent has not yet been developed. The Polyflex stent is a completely new model that represents an improvement over the old metal stents. We have used this stent in a prospective study and herein our present preliminary results. METHODS: In 14 patients with nonresectable esophageal carcinoma, the Polyflex stent was implanted to reduce dysphagia. The grade of dysphagia, the complications following intervention, and the patients' total survival time were documented prospectively every 4 weeks. RESULTS: The implantation of the stent was successful in all cases. The grade of the dysphagia was reduced from 3.0 to 0.5 after stent implantation. One patient died during the hospital stay from a non-stent-induced complication. Stent dislocation occurred once, and tumor overgrowth at the stent margins was observed twice. The mean survival time was 6.2 months, and the reintervention rate was 21.3%. CONCLUSION: The new Polyflex stent, which is based on a completely new design, can be implanted without any difficulty and has had very good short- and long-term results. Therefore, it is a worthy alternative to the metal stents in current use.     

内镜光动力微创疗法治疗胆管癌的临床疗效分析

【摘要】〓目的〓探讨内镜光动力微创疗法(PDT)联合支架置入术治疗胆管癌的临床疗效。方法〓将2005年10月至2009年6月我院收治的62例胆管癌患者分为两组,对照组32例,给予内镜下支架置入术;治疗组30例,在支架置入术的基础上,给予内镜下光动力治疗。对62例晚期胆管癌患者的生存时间及生活质量进行随访。 结果〓经过3年以上的随访,治疗组中位生存时间18个月,1、2、3年生存率分别为63.3%、43.3%及20.0%;对照组中位生存时间8个月,1、2、3年生存率分别为43.8%、25.0%及9.4%,生活质量FACT-Hep量表术后6个月、9个月及12个月,治疗组量表总分明显高于对照组(P<0.05),术前胆红素水平、远处转移及治疗方法是影响胆管癌患者生存期的独立预后因子。结论〓内镜光动力微创疗法(PDT)联合支架置入术提高了胆管癌患者的生存率,改善了生活质量,是胆管癌一种有效的治疗方法。     

Esophageal Stenting and Radiotherapy: A Multimodal Approach for the Palliation of Symptomatic Malignant Dysphagia

Background

Esophageal stents provide immediate palliation of malignant dysphagia; however, radiotherapy (RT) is a superior long-term option. We review the outcomes of combined esophageal stenting and RT for patients with malignant dysphagia.

Methods

We retrospectively reviewed patients with esophageal stents placed for palliation of malignant dysphagia from esophageal stricture, esophageal extrinsic compression, or malignant tracheoesophageal fistula (TEF). We excluded patients with radiation-induced TEF in the absence of tumor. We analyzed and compared outcomes between patients with no RT, RT before stent placement, and RT after stent placement.

Results

We placed stents in 45 patients for esophageal stricture from esophageal cancer (n?=?30; 66.7?%), malignant TEF (n?=?8; 17.7?%), and esophageal compression from airway, mediastinal, or metastatic malignancies (n?=?7; 15.6?%). Twenty patients (44.4?%) had no RT; 25 patients had RT before stent placement (n?=?16; 35.6?%), RT after stent placement (n?=?8; 17.8?%), or both (n?=?1; 2.2?%). Median follow-up was 30?days. Complications requiring stent revision were similar with or without RT. Subjective symptom relief was achieved in 68.9?% of all patients, with no differences noted between groups (p?=?0.99). The 30-day mortality was 15.6?%. Patients with RT after stent placement had a longer median survival compared to those without RT (98 vs. 38?days).

Conclusions

Esophageal stent placement with RT is a safe approach for malignant dysphagia.