Nwokolo C U, Payne-James J J, Silk D B, Misiewicz J J, Loft D E
Department of Gastroenterology, Walsgrave Hospital, Coventry.
Gut. 1994 Mar;35(3):299-303. doi: 10.1136/gut.35.3.299.
Thirty two patients (74 (43-93) years; median, (range)) with dysphagia because of inoperable, unresectable or recurrent oesophagogastric carcinoma were treated by ethanol induced tumour necrosis (ETN). Endoscopic injection of absolute alcohol was performed using a variceal injector needle, with 0.5-1 ml aliquots injected retrogradely from distal to proximal tumour margin. Dilatation to 12 mm was used only if the endoscope would not traverse the stricture. In patients with total occlusion, injection into the proximal tumour was followed by a repeat endoscopy 3-7 days later. Dysphagia was graded from 0 = no dysphagia to 4 = total dysphagia. The significance of changes in the dysphagia grade after ETN were assessed using the Wilcoxon rank sum test. Results (median (range)) were as follows: stricture length = 5.0 cm (1-15). Dysphagia grade before treatment was 3 (2-4) improving after first treatment to 1 (0-3), p < 0.003. Best dysphagia grade achieved was 1 (0-3) and interval between treatments was 28.5 days (4-170). The volume of ethanol injected = 10 ml (1.5-29) and survival after first treatment was 93 days (6-660). The number of treatment sessions required to achieve best grade = 1 (1-3). There were no treatment complications. ETN significantly improves dysphagia. Results of palliation are similar to those of laser therapy, but can be achieved quickly and safely on a day case basis in most patients and at a small proportion of the cost.
32例（年龄74（43 - 93）岁；中位数，（范围））因无法手术、不可切除或复发性食管胃癌导致吞咽困难的患者接受了乙醇诱导肿瘤坏死（ETN）治疗。使用静脉曲张注射针进行内镜下无水乙醇注射，从肿瘤远端向近端边缘逆行注射0.5 - 1 ml aliquots。仅在内镜无法通过狭窄部位时才进行扩张至12 mm。对于完全闭塞的患者，在向近端肿瘤注射后3 - 7天进行重复内镜检查。吞咽困难程度从0级 = 无吞咽困难到4级 = 完全吞咽困难进行分级。使用Wilcoxon秩和检验评估ETN后吞咽困难分级变化的意义。结果（中位数（范围））如下：狭窄长度 = 5.0 cm（1 - 15）。治疗前吞咽困难分级为3级（2 - 4），首次治疗后改善至1级（0 - 3），p < 0.003。达到的最佳吞咽困难分级为1级（0 - 3），治疗间隔为28.5天（4 - 170）。注射乙醇体积 = 10 ml（1.5 - 29），首次治疗后的生存期为93天（6 - 660）。达到最佳分级所需的治疗次数 = 1次（1 - 3）。无治疗并发症。ETN显著改善吞咽困难。姑息治疗结果与激光治疗相似，但在大多数患者中可以在日间手术基础上快速、安全地实现，且成本仅为一小部分。
