伴先兆穿孔征象食管癌动脉内灌注化疗的 疗效和并发症分析

目的评价伴先兆穿孔征象食管癌动脉内灌注化疗的近期疗效、治疗风险和临床应用价值.方法对87例伴先兆穿孔征象食管癌初治患者,采用Seldinger技术进行肿瘤供血靶动脉的选择性插管和造影,并经导管灌注化疗药物.结果 87例患者经动脉灌注化疗后近期疗效为:完全缓解35例,部分缓解44例,无变化7例,进展1例,总有效率90.8%(79/87).本组经治疗后,81例(93.1%)溃疡X线征消失.治疗过程中38例(44.0%)患者溃疡消失后出现可逆性食管狭窄,但随治疗次数的增多和病变的恢复变窄的管腔再度增宽.本组1例并发食管穿孔,形成食管-气管瘘而死亡.1例于再次治疗后发生较为严重的药物性食管炎,病变段及正常食管段分别形成食管深溃疡.结论动脉内灌注化疗治疗伴先兆穿孔征象食管癌是一种较好的疗法.但应重视和预防严重并发症的发生.

Analysis of therapeutic effects and complications of arterial infusion chemotherapy of esophageal cancer with the omen signs of perforation

Objective To evaluate the recent efficacy, therapeutic risk and clinical value of arterial infusion chemotherapy of esophageal cancer with the omen signs of perforation. Methods Eighty-seven cases of esophageal cancer with the omen signs of perforation were treated with selective transcatheter arterial perfusion chemotherapy with Seldinger technique. Results The recent efficacy of 87 cases treated with arterial perfusion chemotherapy was that 35 cases achieved complete response (CR), 44 cases gained partial response (PR), 7 cases were no change (NC) and one case was progressive. The total response rate was 90.8% (79/87). After treating, the X signs of ulcer of 81 cases were vanished. Of them the ulcer of 38 cases were disappeared and then appeared reversible constriction. However the constriction could relieved with therapeutic times improving. Esophageal perforation was occurred in one case and severe esophagitis was occurred in one case treated twice. Conclusion It is a better method to treat esophageal cancer with the omen signs of perforation with arterial perfusion chemotherapy, but severe complications should be prevented and taken seriously.