Parker C H, Peura D A
Division of Gastroenterology, University of Virginia Health Sciences Center, Charlottesville, Virginia.
Gastroenterol Clin North Am. 1991 Dec;20(4):717-29.
Esophageal cancer is incurable in most patients. Tumor anatomy must be carefully defined using radiographic and endoscopic techniques. These techniques can also provide useful information to plan palliative treatment. The goals of palliation must be explicitly discussed and defined with the patient and family. Palliative manipulation is best done by a physician with experience in the procedures, after consideration of all available options to ensure effective palliation with minimal risk of complications. Esophageal dilation is an integral part of most palliative treatment programs, either as sole or adjunctive therapy. Dilation can maintain luminal patency in most patients and can be performed easily, effectively, and safely in an outpatient setting. An esophageal prosthesis can further alleviate symptoms in patients in whom more conventional palliative techniques are unsuccessful. Because prosthesis placement is associated with a relatively high rate of complications, it should be reserved for patients with advanced refractory disease or tracheo-esophageal fistula, for whom no other palliative alternatives exist.
大多数食管癌患者无法治愈。必须使用影像学和内镜技术仔细明确肿瘤解剖结构。这些技术还可为制定姑息治疗方案提供有用信息。必须与患者及其家属明确讨论并界定姑息治疗的目标。在考虑所有可用选项以确保以最小的并发症风险实现有效姑息治疗后，由有操作经验的医生进行姑息治疗操作最为合适。食管扩张是大多数姑息治疗方案不可或缺的一部分，可作为单一疗法或辅助疗法。扩张可维持大多数患者的管腔通畅，且可在门诊轻松、有效且安全地进行。对于采用更传统姑息技术未成功的患者，食管支架可进一步缓解症状。由于支架置入相关并发症发生率相对较高，应仅用于患有晚期难治性疾病或气管食管瘘且没有其他姑息治疗选择的患者。
