金属支架置入联合放、化疗治疗恶性食管狭窄的临床分析

背景与目的:伴有吞咽困难症状的食管癌患者置入自膨式食管金属支架(self-expandingesophagealmetalstents,SEMS)后,是否进行放疗或/和化疗等综合治疗,尚存在较大争议,目前缺乏系统的对比研究。本研究拟探讨SEMS联合放、化疗治疗恶性食管狭窄的价值。方法:将283例患者分为单纯置入SEMS组(n=91)和综合治疗组(n=192),对两组的生存时间进行对比,采用Cox回归模型对生存时间的影响因素(包括治疗方式、是否有远处转移和淋巴结转移、有无瘘道形成以及病变部位)进行分析。结果:综合治疗组的生存时间明显长于单纯置入SEMS组,分别为(499.27±239.37)天和(312.81±192.77)天(P<0.0001)。影响生存时间的因素中,治疗方式的相对危险度最大。结论:安置SEMS后联合放疗或/和化疗对延长伴有吞咽困难症状的食管癌患者的生存时间更有效。

Value of radiotherapy and chemotherapy after SEMS implantation operation in patients with malignant esophageal stricture

BACKGROUND & OBJECTIVE: Owing to the lack of a systematic comparative study, it still remains a controversial issue whether a patient with malignant esophageal tumor causing dysphagia should receive radiotherapy or/and chemotherapy after the SEMS (self-expanding esophageal metal stents) implantation operation. The present paper aims at a careful study of this field. METHODS: A total of 283 specimens were divided into two groups, namely, the group merely receiving the SEMS implantation operation (Group 1, n=91) and the group receiving a combined treatment of the SEMS implantation operation followed by radiotherapy /and chemotherapy (Group 2, n=192). The survival time of the patients in the two different groups was compared and the factors associated with the survival time were analyzed by means of Cox regression method. RESULTS: The survival time of the patients in group 2 was apparently much longer than that of the patients in group 1 (499.27+/-239.7 days and 312.81+/-192.77 days, respectively, P< 0.0001). The factors associated with the survival time included the choice of treatment method, incidence of distant metastasis and lymph node metastasis, formation of esophageal fistula and the location of diseased area. Among them the relative risk of treatment method is the highest. CONCLUSION: A combined treatment of SEMS implantation operation followed by radiotherapy and chemotherapy is significantly associated with the effect of treatment and will undoubtedly prolong the life of the patients with malignant esophageal tumor causing dysphagia.