恶性吞咽困难的内镜下姑息治疗：不可切除食管癌中的一项具有挑战性的任务。

Endoscopic palliation of malignant dysphagia: a challenging task in inoperable oesophageal cancer.

作者信息

Katsoulis I E, Karoon A, Mylvaganam S, Livingstone J I

机构信息

Upper Gastrointestinal Surgery Unit, Watford General Hospital and Mount Vernon Centre for Cancer, Northwood, London, UK.

出版信息

World J Surg Oncol. 2006 Jul 4;4:38. doi: 10.1186/1477-7819-4-38.

DOI:10.1186/1477-7819-4-38

PMID:16820062

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1540418/

Abstract

BACKGROUND

The main goal when managing patients with inoperable oesophageal cancer is to restore and maintain their oral nutrition. The aim of the present study was to assess the value of endoscopic palliation of dysphagia in patients with oesophageal cancer, who either due to advanced stage of the disease or co-morbidity are not suitable for surgery.

PATIENTS AND METHODS

All the endoscopic palliative procedures performed over a 5-year period in our unit were retrospectively reviewed. Dilatation and insertion of self-expandable metal stents (SEMS) were mainly used for tight circumferential strictures whilst ablation with Nd-YAG laser was used for exophytic lesions. All procedures were performed under sedation.

RESULTS

Overall 249 palliative procedures were performed in 59 men and 40 women, with a median age of 73 years (range 35-93). The median number of sessions per patient was 2 (range 1-13 sessions). Palliation involved laser ablation alone in 24%, stent insertion alone in 22% and dilatation alone in 13% of the patients. In 41% of the patients, a combination of the above palliative techniques was applied. A total of 45 SEMS were inserted. One third of the patients did not receive any other palliative treatment, whilst the rest received chemotherapy, radiotherapy or chemoradiotherapy. Swallowing was maintained in all patients up to death. Four oesophageal perforations were encountered; two were fatal whilst the other two were successfully treated with covered stent insertion and conservative treatment. The median survival from diagnosis was 10.5 months (range 0.5-83 months) and the median survival from 1st palliation was 5 months (range 0.5-68.5 months).

CONCLUSION

Endoscopic interventions are effective and relatively safe palliative modalities for patients with oesophageal cancer. It is possible to adequately palliate almost all cases of malignant dysphagia. This is achieved by expertise in combination treatment.

摘要

背景

对于无法手术的食管癌患者，治疗的主要目标是恢复并维持其经口营养。本研究的目的是评估内镜下缓解食管癌患者吞咽困难的价值，这些患者因疾病晚期或合并症而不适合手术。

患者与方法

回顾性分析了本单位5年内进行的所有内镜姑息治疗手术。扩张和置入自膨式金属支架（SEMS）主要用于治疗环形紧密狭窄，而用钕钇铝石榴石激光消融用于治疗外生性病变。所有手术均在镇静下进行。

结果

共对59名男性和40名女性进行了249次姑息治疗手术，中位年龄为73岁（范围35 - 93岁）。每位患者的手术次数中位数为2次（范围1 - 13次）。24%的患者仅接受激光消融，22%的患者仅置入支架，13%的患者仅接受扩张。41%的患者采用了上述姑息治疗技术的联合应用。共置入45个SEMS。三分之一的患者未接受任何其他姑息治疗，其余患者接受了化疗、放疗或放化疗。所有患者直至死亡时吞咽功能均得以维持。发生了4例食管穿孔；2例死亡，另外2例通过置入覆膜支架和保守治疗成功治愈。从诊断开始的中位生存期为10.5个月（范围0.5 - 83个月），从首次姑息治疗开始的中位生存期为5个月（范围0.5 - 68.5个月）。