食管癌放疗穿孔防治研究进展

目的 食管癌是消化道常见肿瘤,放射治疗是食管癌的有效治疗方式之一,而食管穿孔是食管癌放疗的严重并发症,一旦出现,多数患者短期内死亡.本研究旨在通过总结国内外食管癌放疗穿孔防治的研究进展,提高对食管癌放疗穿孔的认识,以改善其生存及预后.方法 应用PubMed、中国知网、万方数据库和维普中文期刊服务平台等检索系统,以“食管癌、食管恶性肿瘤食管穿孔、瘘、放射治疗、放疗、近距离放射疗法、腔内放疗、诊断、预防和治疗”为关键词,检索1996-2016相关文献,共筛选出51篇高度相关文献.结果 食管癌放疗穿孔的高危因素有T4期、二程放疗等,应注意密切监测放疗反应,谨防穿孔.出现胸痛、呛咳和发热等症状时可通过食管X射线检查、食管CT等检查尽早明确诊断,据情况予手术或介入治疗.结论 食管癌放疗穿孔可防可治,临床工作中应注意密切监测放疗不良反应,重视放疗穿孔的预防,一旦发生穿孔,要尽早诊断、尽早治疗,改善生存质量,延长生存期.

Prevention and treatments of esophageal perforation during or after radiotherapy in esophageal carcinoma: a review of literature

OBJECTIVE Esophageal carcinoma is one of the most common malignant neoplasms in China.Radiotherapy is an important and effective management,of which esophageal perforation is a disastrous complication.This review was to enhance our recognition of the esophageal perforation during or after radiation therapy by reviewing the progress of researches on radiotherapy related esophageal perforation in esophageal carcinoma.METHODS "esophageal carcinoma,esophageal neoplasm,esophageal perforation,fistula,radiation therapy,radiotherapy,brachytherapy,intraluminal radiotherapy,prevention and treatment" were checked as keywords in PubMed,CNKI,Wanfang data,VIP databases between 1996 and 2016.RESULTS Based on 51 highly-related papers,the risk factors for esophageal perforation include T4 stage and a second course of radiotherapy to the esophagus.Patients at high risk for developing esophageal perforation should be given particular care to avoid it.Frequent symptoms include chest pain,cough and fever.Esophageal X-ray and CT are useful for establishing the diagnosis.Operation and intervention are effective salvage therapies for esophageal perforation.CONCLUSIONS Esophageal perforation during or after radiotherapy is preventable and treatable.Close attention should be paid to detect radiotherapy related adverse events and prevent perforation.Once perforation was occurred,earlier diagnosis and treatment is needed to improve the quality of life and survival.