晚期食管癌附膜金属内支架置入对放疗后穿孔的预防和治疗价值

目的　通过回顾研究 ,比较附膜金属内支架置入结合放疗和单纯放疗治疗晚期食道癌所致食道穿孔的发生率。评价附膜金属内支架置入对放疗后食道穿孔的预防和治疗价值。方法　 1996年 6月～ 2 0 0 0年 6月 ,97例晚期食管癌患者中 ,5 2例单纯行放射治疗 ,45例行附膜金属内支架置入结合放疗。治疗前均行食道吞钡检查 ,部分病例行食道镜检查 ,并取得组织学诊断。对支架置入前后的吞咽能力进行评分。对放疗后食道穿孔的发生率进行对比分析。结果　 5 2例单纯放疗病人有 7例发生食道穿孔 ,其中食道气管瘘 2例、食道纵隔瘘 4例、1例食道主动脉穿孔 ,后者因迅速出血性休克而死亡。 45例附膜金属内支架置入结合放疗的病人未见食道穿孔的现象发生 (其中包括 5例放疗穿孔后再行附膜支架置入的病人 )。 45例病人共置入 5 1个支架 ,其中 6例需置入 2个支架。在支架置入后吞咽功能均立即获得改善。结论　晚期食道癌附膜金属内支架置入对放疗后穿孔的预防和治疗作用是肯定的。

Effect of covered-metallic stent placement on postradiotherapy esophageal perforation in patients with unresectable esophageal carcinoma

Objective To retrospectively compare the incidence of esophageal perforation between the patients treated by radiotherapy combined with covered metallic stents implanation and by radiotherapy alone,and to assess the value of covered metallic stent in the prevention and treatment of postradiotherapy esophageal perforation.Methods From June 1996 to June 2000,97 patients with unresectable esophageal carcinoma were treated by covered metallic stent with radiotherapy (n=45) and radiotherapy alone (n=52).Esophageal X ray double contrast examinations were performed on all these patients (some with esophagoscopy examinations also)and the diagnosis was confirmed by pathology before treatment.The incidence of postradiotherapy esophageal perforation was analyzed and the degree of dysphagia was evaluated.Results Complications occurred in 52 patients by radiotherapy alone,which included esophagotracheal fistula(n=2),esophageal mediastinal fistula(n=4) and esophageal aortic perforation (n=1, one died due to bleeding shock).Esophageal perforation did not occur in 45 patients treated by covered stent with radiotherapy.Of the 45 patients,5 with postradiotherapy esophageal perforation were placed covered metallic stents again.Dysphagia had been relieved after stents were placed in all the 45 patients.Conclusion Covered metallic stent is definitely effective in the prevention and treatment of postradiotherapy esophageal perforation for patients with unresectable esophageal carcinoma.