自膨式金属支架置入术改善胃食管交界处腺癌患者呑咽困难的临床价值

[目的]探讨自膨式金属支架(SEMS)置入术改善胃食管交界处腺癌患者吞咽困难的价值及安全性。[方法]纳入已失去手术机会或拒绝手术治疗的胃食管交界处腺癌伴吞咽困难患者48例,按患者意愿分为SEMS置入治疗组及不置入SEMS的对照组,记录SEMS置入过程中及之后1周的症状及不良反应,并于3、6、12个月对2组患者进行症状、辅助检查及生存状况随访。[结果]治疗组25例患者,均一次性成功置入SEMS,在置入过程中未出现明显并发症,其中96.00%(24/25)患者置入支架后吞咽困难症状明显改善;对照组23例经给予促动力药等治疗后,仅8.69%(2/23)症状稍改善;2组比较差异有统计学意义(P=0.000)。6个月、12个月的生存率治疗组分别为64.00%、48.00%,对照组分别为30.43%、0%,治疗组的生存时间明显长于对照组(P=0.021、0.000)。[结论]SEMS置入术是比较安全的治疗胃食管交界处腺癌吞咽困难的方法,可明显改善患者生活质量并明显延长生存时间。

Value and safety self-expanding metal stents on treatment of dysphagia in gastro-oesophageal junction adenocarcinoma patients

[Objective]To investigative value and safety of self-expanding metal stents（SEMS）on treat-ment of dysphagia in gastro-oesophageal junction（GEJ）adenocarcinoma patients.[Methods]Forty-eight ca-ses of gastro-oesophageal junction adenocarcinoma patients with dysphagia ,which were all unresectable or refused surgical treatment ,were involved.The patients were divided into treatment group with deploymen-ting SEMS and control group without any therapy.Adverse reactions during and one week after treatment in treatment group were recorded.The follow-up point included 3 months ,6 months ,12 months after de-ployment of SEMS was performed in treatment group and control group ,including symptoms ,auxiliary ex-amination and survival time ,examinations. [Results] Twenty-five patients were successfully implanted SEMS one time ,no serious complications were observed during the process ,nine cases had chest pain ,seven cases showed nausea and vomiting ,but the symptoms were relieved within 1 week after treatment.The dys-phagia in treatment group was improved significantly 96.00% （24/25）after treating.However ,only 8.69%（2/23）of patients in the control group improved after treating with prokinetic drugs and other drugs.The difference between these two groups was significant （P= 0.000）.Six-months survival rate in treatment group was 64.00% and twelve-months survival rate was 48.00%.While the survival rate in control group were 30.43% ,0% respectively ,which were significantly lower（Pwere 0.021 and 0.000）.[Conclusions]＆amp;nbsp;SEMS placement is a relatively safe method for gastro-oesophageal junction（GEJ）adenocarcinoma patients with dysphagia ,and it can significantly improve the quality of life and significantly prolong survival time of patients.