Foco A, Garbarini A, Serenthà U, Giordano O, Rozzio G, Leli R, Fontana D, Voghera P, Graziano L, Galasso F
Chirurgia d'Urgenza, Università degli Studi di Torino.
Minerva Gastroenterol Dietol. 1993 Mar;39(1):11-6.
The authors examined a series of 231 patients suffering from unoperable neoplastic dysphagia of the esophagus and treated using prevalently palliative endoscopic methods (photocoagulation and/or intubation) during the period 1980-1991. They draw the following conclusions: a) endoscopic methods are better than surgical techniques; b) there are a greater number of indications for endoscopic intubation than for photocoagulation (approximately 2 to 1); c) some situation which are indicated for photocoagulation are not contraindicated for intubation; d) the sole contraindication for intubation is stenosis in which the proximal limit is less than 2 cm from the upper esophageal sphincter; e) contraindications for photocoagulation are long stenoses and/or those of the infiltrating type, and/or involving the upper third of the esophagus; f) sometimes the two methods may be complementary in the sense that intubation may be preceded by a few photocoagulation sessions in order to necrotize the vegetating portion of an infiltrating tumour; g) it is best to choose intubation wherever possible since this technique is less expensive and the quality of remaining life better, even if the percentage of severe and generally fatal complications (perforation) is still too high; h) the possible introduction of expandable metal prostheses might increase indications for intubation and reduce the number of severe complication.
作者对1980年至1991年期间的231例患有无法手术的食管癌性吞咽困难且主要采用姑息性内镜治疗方法（光凝和/或插管）的患者进行了研究。他们得出以下结论：a）内镜治疗方法优于手术技术；b）内镜插管的适应证比光凝更多（约为2比1）；c）一些适用于光凝的情况并非插管的禁忌证；d）插管的唯一禁忌证是近端距食管上括约肌小于2 cm的狭窄；e）光凝的禁忌证是长段狭窄和/或浸润型狭窄，和/或累及食管上段的狭窄；f）有时这两种方法可能具有互补性，即插管前可先进行几次光凝治疗，以使浸润性肿瘤的赘生物部分坏死；g）只要有可能最好选择插管，因为该技术费用较低且剩余生活质量更好，即使严重且通常致命的并发症（穿孔）发生率仍然过高；h）可扩张金属支架的可能应用可能会增加插管的适应证并减少严重并发症的数量。
