Sawant D, Moghissi K
Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, Hull, UK.
Eur J Cardiothorac Surg. 1994;8(3):113-6; discussion 117. doi: 10.1016/1010-7940(94)90164-3.
We compared and contrasted the potentials of palliation afforded by various management methods in a retrospective study of all patients referred to one surgical team in a 20-year period. Five hundred thirty-seven patients had unresectable oesophageal cancer. There were five treatment groups: group 1-dilatation plus external radiotherapy (DXR, n = 95), group 2-gastrostomy plus DXR (n = 18), group 3-permanent intubation (n = 329), group 4-oesophageal bypass (BP, n = 70), and group 5-YAG laser plus brachytherapy (n = 25). Groups 1 and 2 had high mortality (4% and 25%) and poor symptom relief, with an average survival of 2.5 and 3.5 months, respectively. Group 3 had a 20% mortality rate, moderate-to-good symptom relief and an average survival of 4.2 months. This method was best for lower oesophageal cancer. Group 4 had a 22% mortality rate, good symptom relief and an average survival of 10.5 months. The BP method was suitable for patients with oesophago-airway fistula (OAF) and those with lower oesophageal cancer found unresectable at operation. Group 5 had a hospital mortality rate of 8%, good symptom control and an average survival of 6.2 months. This was suitable for all patients (except those with OAF). In palliation of carcinoma of the oesophagus the selection of method should be made to suit the characteristic and location of the tumour.
在一项对20年间转诊至某一外科团队的所有患者的回顾性研究中，我们比较并对比了各种治疗方法所提供的姑息治疗潜力。537例患者患有无法切除的食管癌。共有五个治疗组：第1组——扩张术加体外放疗（DXR，n = 95），第2组——胃造口术加DXR（n = 18），第3组——永久性插管（n = 329），第4组——食管旁路术（BP，n = 70），以及第5组——YAG激光加近距离放疗（n = 25）。第1组和第2组死亡率高（分别为4%和25%）且症状缓解不佳，平均生存期分别为2.5个月和3.5个月。第3组死亡率为20%，症状缓解程度为中度至良好，平均生存期为4.2个月。该方法对下段食管癌最为适用。第4组死亡率为22%，症状缓解良好，平均生存期为10.5个月。BP方法适用于食管气管瘘（OAF）患者以及术中发现无法切除的下段食管癌患者。第5组医院死亡率为8%，症状控制良好，平均生存期为6.2个月。这适用于所有患者（除OAF患者外）。在食管癌的姑息治疗中，应根据肿瘤的特征和部位选择治疗方法。
