Carter R, Smith J S, Anderson J R
University Department of Surgery, Royal Infirmary, Glasgow, UK.
Br J Surg. 1992 Nov;79(11):1167-70. doi: 10.1002/bjs.1800791120.
Forty patients with histologically confirmed malignant dysphagia were randomized to either endoscopic intubation or laser recanalization. Age, sex, tumour histology and site were evenly distributed between the groups. Results were analysed on an 'intention to treat' basis. All patients treated by laser achieved patency; there was one failed intubation. The best swallowing grade achieved was significantly better with laser recanalization (median 4 (range 3-4)) than with intubation (median 3 (range 2-4)) (P < 0.001). The median survival was 21.5 (range 4-62) weeks in the group receiving laser treatment, compared with 14.5 (range 7-102) weeks in the intubated group (P = 0.09). The median inpatient stay as a proportion of survival time was 14 per cent in the group receiving laser treatment compared with 15 per cent in the intubated group (P > 0.05). The median weight loss was less in the laser-treated patients (2.0 (range 2-8) versus 3.0 (range 0-10) kg, P = 0.04). These results indicate that laser recanalization provides better palliation of dysphagia than does intubation, but this is not reflected in an improvement in survival time.
40例经组织学确诊为恶性吞咽困难的患者被随机分为内镜插管组或激光再通组。两组在年龄、性别、肿瘤组织学类型和部位方面分布均衡。结果基于“意向性治疗”原则进行分析。所有接受激光治疗的患者均实现了管腔通畅；有1例插管失败。激光再通组达到的最佳吞咽分级（中位数为4（范围3 - 4））明显优于插管组（中位数为3（范围2 - 4））（P < 0.001）。接受激光治疗组的中位生存期为21.5周（范围4 - 62周），而插管组为14.5周（范围7 - 102周）（P = 0.09）。激光治疗组住院时间中位数占生存时间的比例为14%，插管组为15%（P > 0.05）。激光治疗患者的中位体重减轻较少（2.0（范围2 - 8）kg对3.0（范围0 - 10）kg，P = 0.04）。这些结果表明，与插管相比，激光再通能更好地缓解吞咽困难，但这并未反映在生存时间的改善上。
