Kim Jihye, Min Yang Won, Lee Hyuk, Min Byung Hoon, Lee Joon Haeng, Rhee Poong Lyul, Kim Jae J
Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2018 Mar 25;71(3):124-131. doi: 10.4166/kjg.2018.71.3.124.
BACKGROUND/AIMS: Dysphagia is encountered in a large proportion of patients with lung cancer and is associated with malnutrition and a poor quality of life. This study compared the clinical outcomes of self-expandable metallic stent (SEMS) insertion and percutaneous gastrostomy (PG) feeding for patients with lung cancer and dysphagia.
A total of 261 patients with lung cancer, who underwent either SEMS insertion (stent group) or PG (gastrostomy group) as an initial treatment procedure for dysphagia between July 1997 and July 2015 at the Samsung Medical Center, were reviewed retrospectively, and 84 patients with esophageal obstruction were identified. The clinical outcomes, including the overall survival, additional intervention, complications, and post-procedural nutritional status in the two groups, were compared.
Among the 84 patients finally analyzed, 68 patients received SEMS insertion and 16 had PG. The stent group had less cervical obstruction and more mid-esophageal obstruction than the gastrostomy group. The Kaplan-Meier curves revealed similar overall survival in the two groups. Multivariate analysis showed that the two modalities had similar survival rates (PG compared with SEMS insertion, hazard ratio 0.682, p=0.219). Fifteen patients (22.1%) in the stent group received additional intervention, whereas there was no case in the gastrostomy group (p=0.063). The decrease in the serum albumin level after the procedure was lower in the gastrostomy group than in the stent group (-0.20±0.54 g/dL vs. -0.65±0.57 g/dL, p=0.013).
SEMS insertion and PG feeding for relieving dysphagia by lung cancer had a comparable survival outcome. On the other hand, PG was associated with a better nutritional status.
背景/目的：肺癌患者中很大一部分会出现吞咽困难，且吞咽困难与营养不良及生活质量差相关。本研究比较了自膨式金属支架（SEMS）置入术和经皮胃造瘘术（PG）对肺癌伴吞咽困难患者的临床疗效。
回顾性分析1997年7月至2015年7月在三星医疗中心因吞咽困难接受SEMS置入术（支架组）或PG（胃造瘘组）作为初始治疗的261例肺癌患者，确定84例食管梗阻患者。比较两组的临床疗效，包括总生存期、额外干预、并发症及术后营养状况。
在最终分析的84例患者中，68例接受SEMS置入术，16例接受PG。与胃造瘘组相比，支架组颈段梗阻较少，食管中段梗阻较多。Kaplan-Meier曲线显示两组总生存期相似。多因素分析表明两种治疗方式生存率相似（PG与SEMS置入术相比，风险比0.682，p=0.219）。支架组15例患者（22.1%）接受了额外干预，而胃造瘘组无此情况（p=0.063）。术后胃造瘘组血清白蛋白水平下降幅度低于支架组（-0.20±0.54 g/dL对-0.65±0.57 g/dL，p=0.013）。
SEMS置入术和PG喂养缓解肺癌所致吞咽困难的生存结局相当。另一方面，PG与更好的营养状况相关。
