Vonk-Noordegraaf A, Postmus P E, Sutedja T G
Department of Pulmonary Medicine, University Hospital Vrije Universiteit, Amsterdam, the Nertherlands.
Chest. 2001 Dec;120(6):1811-4. doi: 10.1378/chest.120.6.1811.
To evaluate the palliative benefit of stent insertion in a group of patients with central airways obstruction due to terminal cancer.
Retrospective analysis of the symptomatic score of patients immediately after stent insertion, and questionnaires completed by the general practitioner (GP) after the patients died at home.
Academic hospital, tertiary referral center for interventional bronchoscopy.
Fourteen patients with imminent suffocation due to major obstruction of the central airways, caused by end-stage esophageal cancer (n = 5) and non-small cell lung cancer (n = 9), were referred for stent insertion. All prostheses were placed within 24 h after hospital admittance. Patients were then asked whether their symptoms had improved. After the patients died, a questionnaire was sent to each patient's GP.
All patients expressed immediate benefit after stenting. The average length of survival after stent insertion was 11 weeks (range, 0.5 to 34 weeks). Two patients died within 1 week in our hospital after stent placement. In the remaining 12 patients, the GP considered stent insertion in 7 patients to be worthwhile, no judgment was made in 4 patients, and stent insertion in 1 patient was regarded as futile.
Despite terminal disease and the fact that, in our country, patients may legally refuse any treatment and formally ask for euthanasia, the palliative benefit of stent placement should always be considered. All patients had immediate symptomatic relief afterwards. Retrospectively, the GPs responsible for terminal care at home still considered stent insertion worthwhile in 58% (7 of 12 patients) of cases. Stent placement should always be considered as part of the treatment of terminal cancer patients with imminent suffocation.
评估为一组因晚期癌症导致中央气道阻塞的患者插入支架的姑息治疗效果。
对患者插入支架后即刻的症状评分进行回顾性分析，并在患者在家中死亡后由全科医生（GP）填写问卷。
学术医院，介入支气管镜检查的三级转诊中心。
14例因终末期食管癌（n = 5）和非小细胞肺癌（n = 9）导致中央气道严重阻塞而即将窒息的患者被转诊进行支架插入。所有假体均在入院后24小时内放置。然后询问患者症状是否有所改善。患者死亡后，向每位患者的全科医生发送一份问卷。
所有患者在置入支架后均表示立即受益。置入支架后的平均生存时间为11周（范围为0.5至34周）。2例患者在我院置入支架后1周内死亡。在其余12例患者中，全科医生认为7例患者置入支架是值得的，4例患者未作判断，1例患者置入支架被认为是徒劳的。
尽管患有终末期疾病，且在我国患者可合法拒绝任何治疗并正式要求安乐死，但仍应始终考虑置入支架的姑息治疗效果。所有患者此后症状均立即缓解。回顾性来看，负责在家中进行临终关怀的全科医生仍认为58%（12例患者中的7例）的病例置入支架是值得的。置入支架应始终被视为即将窒息的晚期癌症患者治疗的一部分。
