Pavlidis Theodoros E, Pavlidis Efstathios T
Theodoros E Pavlidis, Efstathios T Pavlidis, Second Surgical Propedeutic Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 54642 Thessaloniki, Greece.
World J Gastrointest Surg. 2014 Mar 27;6(3):38-41. doi: 10.4240/wjgs.v6.i3.38.
Gastroesophageal junction cancer has an increasing incidence in western countries. It is inoperable when first manifested in more than 50% of cases. So, palliation is the only therapeutic option for the advanced disease to relieve dysphagia and its consequences in weakened patients with an estimated mean survival under 6 mo. This article has tried to identify trends focusing on current information about the best palliative treatment, with an emphasis on the role of stenting. Self-expanding stent placement, either metal or plastic, is the main management option. However, this anatomical location creates some particular problems for stent safety and effectiveness which may be overcome by properly designed novel stents. The stents ensure a good quality of life and must be preferred over other alternative methods of loco-regional modalities, i.e., external radiation, laser thermal or photodynamic therapy. Although stent placement is generally a simple, safe and effective method, there are sometimes complications, increasing the morbidity and mortality rate. Bypass operative procedures have now been abandoned as a first choice. The stomach instead of the colon must be used for a bypass operation when it is needed. Chemotherapy, despite the toxicity, and intraluminal radiation (brachytherapy) have a well-defined role.
在西方国家，胃食管交界癌的发病率呈上升趋势。超过50%的病例初发时即无法手术切除。因此，对于晚期疾病，姑息治疗是唯一的治疗选择，以缓解吞咽困难及其对身体虚弱患者的影响，这类患者的平均生存期估计不足6个月。本文试图聚焦于最佳姑息治疗的当前信息，确定相关趋势，重点关注支架置入的作用。自膨式支架置入，无论是金属支架还是塑料支架，都是主要的治疗选择。然而，这个解剖位置给支架的安全性和有效性带来了一些特殊问题，设计合理的新型支架或许可以克服这些问题。支架能确保良好的生活质量，比起其他局部治疗方式，如外照射、激光热疗或光动力疗法等替代方法，更值得首选。尽管支架置入通常是一种简单、安全且有效的方法，但有时也会出现并发症，增加发病率和死亡率。旁路手术现已不再作为首选。如需进行旁路手术，应使用胃而非结肠。化疗尽管有副作用，但腔内放疗（近距离放疗）也有明确的作用。
