食管癌性狭窄内支架置入的时机选择——放射治疗前后的近期疗效比较

目的　通过观察食管癌性狭窄患者 ,在放疗前或后两组内支架置入的不同疗效比较 ,探讨支架置入的最佳时机。方法　随机按食管癌性狭窄内支架置入不同的时间分为两组。放疗前置入组 (A) 2 0例 ,男性 15例 ,女性 5例 ,平均年龄 5 6岁 ;放疗后置入组 (B) 15例 ,男性 11例 ,女性 4例 ,平均年龄 5 4岁。均经球囊扩张食管狭窄段后置入内支架。随访患者 1～ 6个月 ,观察疗效及并发症的发生。结果　 35例支架均一次顺利置入成功。 1周后支架扩张内径 A组 2 0例均 >15 mm ,平均 18m m ;B组扩张 >15 mm仅 1例 ,平均扩张直径为 10 mm ,两组食管内支架置入后扩张程度差异有显著性 (P<0 .0 1)。放疗的时间及剂量与扩张的程度成反比。放疗时间越长、量越大 ,越难扩张。放疗后支架置入并发症增加 ,大出血致死 2例。结论　食管癌性狭窄放疗前内支架置入较放疗后置入安全 ,并发症少 ,疗效可靠

Timing of stent placement into the malignant strictured esophagi and the comparison between ante-radiotherapeutic stenting and post-radiotherapeutic stenting

Objective Through diagnosing the condition of malignant esophageal strictures to choose the best moment for stenting,and make an effect comparison between stenting before radiotherapy and stenting after radiotherapy.Methods Ante-radiotherapeutic stenting group(A):20 cases,male 15,female 5,average age 56;post-radiotherapeutic stenting group(B):15 cases,male 11,female 4,average age 54.All of them were given stenting in their strictured esophagi via balloon dilation,then a one-six-month follow-up was made for detecting the result and complications(if any).Results Thirty-five cases got their stents successful in one time;one week later the stent expanded the strictured areas as follows:more than 15 mm in 20 cases of group A,with a mean of 18 mm;but group B had only one case getting 15 mm and over,with a mean of 10 mm.A significant difference existed between the two groups (P<0.01).The length and dosage of radiotherapy was inversely proportional to the dilation.The longer and the bigger the radiotherapy and its dose were,the harder the dilation was,and even with more complications.Two cases died of massive hemorrhage.Conclusion In treating the malignant esophageal stricture the ante-radiotherapeutic stenting is safer,more effective than the post-radiotherapeutic one,and with less complications.