内镜联合X线监视下支架植入治疗中晚期食管癌恶性梗阻的临床应用

目的探讨内镜联合X线监视下支架植入治疗中晚期食管癌恶性梗阻的临床疗效。 方法选择2010年6月—2017年10月在内蒙古呼和浩特市第一医院中晚期食管癌恶性梗阻的67例患者，根据患者意愿分为内镜联合X线监视下支架植入组(联合组，n＝35)和X线监视下放置支架组(普通组，n＝32)。观察比较两组患者术前及术后1～3个月的生活质量和吞咽困难指数变化情况，观察患者的术后并发症并及时对症治疗；统计术后患者的生存期与存活率，并采用生存质量核心问卷(QLQ-C30)和食管癌专用量表(OES-18)调查患者的生活质量。 结果两组患者均一次性成功植入支架，成功率达100%，吞咽困难立刻改善明显，两组评分由联合组和普通组的(3.3 ±0.6)和(3.2 ±0.7)分改善为(1.0±03)分，1周后的评分均改善为0分。两组患者术中、术后无大出血和穿孔的发生，均有不同程度的胸骨后疼痛和不适，大多数均不需特殊处理。联合组患者的再阻塞率、生存时间、生存质量明显高于普通组患者(P<0.05)，联合组的再阻塞率明显低于普通组患者(P<0.05)；但两组间支架移位率无统计学差异(P>0.05)。 结论应用内镜和X线双重定位下植入支架治疗不愿或不能手术切除的中晚期食管癌患者，具有创伤小、安全、定位准确等特点，能迅速缓解患者的症状，提高生存质量，延长生存时间，具有良好的临床应用价值。

Clinical application of stent implantation monitoring with endoscope and X-ray in the treatment of malignant obstruction of late esophageal carcinoma

ObjectiveTo investigate the clinical efficacy of stent implantation monitoring with endoscope and X-ray in the treatment of malignant obstruction of late esophageal carcinoma. MethodsFrom June 2010 to October 2017, 67 patients with malignant obstruction of late esophageal cancer in the First Hospital of Hohhot, Inner Mongolia, were divided into the joint group (n=35) who underwent stent implantation monitoring with endoscope and X-ray, and the normal group (n=32) who underwent stent implantation monitoring with only X-ray. The quality of life and dysphagia index of the two groups were compared before operation and 1 to 3 months after operation. The postoperative complications were observed and relevant treatments were performed. The lifetime and survival rates of the patients were counted. Quality of Life Questionnaire-Core (QLQ-C30) and Esophageal Cancer Special Scale (OES-18) were used to investigate the life quality of the patients. ResultsThe stents were successfully implanted at the first time for the two groups with 100% success rate, and the dysphagia was immediately improved. The scores were improved from 3.3±0.6 and 3.2±0.7 points to 1.0±0.3 in the joint group and the normal group respectively. The scores after 1 week were improved to 0 point in the two groups. There were no major hemorrhages and perforations in the two groups during and after surgery. Both groups had varying degrees of retrosternal pain and discomfort, but most patients did not require special treatment. The survival time and life quality of the joint group were significantly better than those of the normal group (P<0.05), and the re-occlusion rate of the joint group was significantly lower than that of the normal group (P<0.05). There were no statistically differences in the stent relocation rate between the groups (P>0.05). ConclusionsThe application of stent implantation monitoring with endoscope and X-ray on the patients who suffer from late esophageal carcinoma and cannot undergo surgery has the advantages of small trauma, higher safety and accurate positioning, which can quickly relieve the symptoms, improve the life quality and prolong the survival time.