Department of Thoracic Surgery and Surgical Oncology, John Paul II Hospital, Cracow, Poland.
Department of Thoracic Surgery and Surgical Oncology, John Paul II Hospital, Cracow, Poland; Jagiellonian University, Collegium Medicum, Cracow, Poland.
Ann Palliat Med. 2023 Jul;12(4):738-747. doi: 10.21037/apm-22-1144. Epub 2023 Jul 11.
Due to the close anatomical relationship between the esophagus and the bronchial tree, lung cancer can cause malignant dysphagia. Patients with this complication may require palliation through esophageal and/or bronchial tree restoration.
Between the years 2008 and 2018, malignant dysphagia was diagnosed in 84 lung cancer patients. Their response to esophageal and/or bronchial tree stenting was studied retrospectively. Patients were stratified into three groups: esophageal compression without obstruction of the bronchi (Group I, n=64), esophageal compression and bronchial obstruction without fistulas (Group II, n=12), and dysphagia and esophagotracheal fistula (Group III, n=8). Group I had one stent implanted, whilst in Groups II and III, two stents were introduced. Both self-expanding stents and silicone Y stents were utilized. Prior to intervention and during the follow-up period, patients were assessed for degree of dysphagia and dyspnea, quality of life, and survival.
Following endoprosthetic restoration, dysphagia score improved in all patient groups with reductions in Group I (2.68 vs. 1.2, P=0.0001), in Group II (2.76 vs. 1.3, P=0.0001), and in Group III (2.74 vs. 1.3, P=0.0001). There was no dyspnea recorded in Group I before an intervention, however it was present and reduced in Group II (2.86 vs. 0.4, P=0.001) and Group III (2.89 vs. 0.5, P=0.0001) following intervention. Quality of life was improved for all patient groups, with an increase in Karnofsky performance scale in Group I (56 vs. 72, P=0.0001), Group II (56 vs. 70, P=0.0001) and Group III (53 vs. 67, P=0.0001). Three patients (3.6%) developed respiratory failure and 1 patient (0.8%) died. Two patients (2.4%), following esophageal stenting, required bronchial tree stenting. Dysphagia occurred in 5 patients (6.0%) due to granuloma formation. In these cases, the stents were removed and re-stenting was carried out. In 3 of the patients (3.6%) the stents were removed due to migration and re-stenting was performed.
Patients with malignant dysphagia due to lung cancer may require esophageal stenting as well as bronchial tree stenting. This treatment offers improvements in dysphagia and dyspnea scores, as well as in quality of life, and allows for the implementation of oncological treatments.
由于食管和支气管树之间的解剖关系密切，肺癌可导致恶性吞咽困难。有这种并发症的患者可能需要通过食管和/或支气管树修复来缓解。
在 2008 年至 2018 年间，84 例肺癌患者被诊断为恶性吞咽困难。回顾性研究了他们对食管和/或支气管树支架置入的反应。患者分为三组：无支气管阻塞的食管压迫（第 I 组，n=64）、食管压迫伴无瘘管的支气管阻塞（第 II 组，n=12）和吞咽困难伴食管气管瘘（第 III 组，n=8）。第 I 组植入一个支架，而在第 II 组和第 III 组中，引入了两个支架。使用了自膨式支架和硅胶 Y 支架。在干预前和随访期间，评估患者的吞咽困难和呼吸困难程度、生活质量和生存情况。
在所有患者组中，在进行植入后，吞咽困难评分均得到改善，在第 I 组中（从 2.68 降至 1.2，P=0.0001），在第 II 组中（从 2.76 降至 1.3，P=0.0001），以及在第 III 组中（从 2.74 降至 1.3，P=0.0001）。第 I 组在干预前没有呼吸困难，但在第 II 组（从 2.86 降至 0.4，P=0.001）和第 III 组（从 2.89 降至 0.5，P=0.0001）中存在并减少。所有患者组的生活质量均得到改善，在第 I 组中（从 Karnofsky 表现量表的 56 升至 72，P=0.0001）、第 II 组（从 56 升至 70，P=0.0001）和第 III 组（从 53 升至 67，P=0.0001）中增加。有 3 名患者（3.6%）发生呼吸衰竭，1 名患者（0.8%）死亡。2 名患者（2.4%）在食管支架置入后需要支气管树支架置入。5 名患者（6.0%）因肉芽肿形成而出现吞咽困难。在这些情况下，支架被移除并重新进行支架置入。在 3 名患者（3.6%）中，由于支架迁移而移除了支架，并进行了重新支架置入。
由于肺癌导致恶性吞咽困难的患者可能需要食管支架置入和支气管树支架置入。这种治疗方法可改善吞咽困难和呼吸困难评分，提高生活质量，并允许实施肿瘤治疗。
