Mambrini P, Audibert P, Barthet M, Bertolino J G, Brequeville J M, Amoros F, Salducci J, Grimaud J C
Service d'Hépato- Gastroentérologie, Hopital Nord, Marseille.
Gastroenterol Clin Biol. 1996;20(10):844-51.
OBJECTIVE, PATIENTS AND METHODS: The objective of this study was to evaluate the results of palliative bipolar electrocoagulation probe (BICAP) treatment in 26 patients with non surgical, obstructive esophageal cancer. The mean tumor length was 7.2 cm. The strictures were located as follows: 3 in the cervical esophagus, 8 in the thoracic esophagus, 13 in the distal third of the esophagus and 2 involved both the cervical and thoracic esophagus. Most lesions were circumferential (73% versus 27% non circumferential) and exophytic (78% versus 22% sub mucosal). Coagulation was carried out under direct endoscopic control in the forward direction. The success of treatment was evaluated on the basis of the degree of reopening achieved (easy passage of an endoscope 12 mm in diameter) and good functional results (improvement of dysphagia, scored from 0 to 4 using a standard grading scale, for more than 15 days).
Twenty-six patients underwent a total of 45 BICAP treatments (31 initial sessions, 14 repeated sessions). Reopening was achieved in 92% of cases and good functional results were obtained in 85% (mean dysphagia score: 3.2 before treatment versus 1.1 after treatment). The improvement of dysphagia resulted in a significant improvement of general performance status and stabilization or weight improvement in 21 patients. The mean number of sessions necessary for good initial results was 1.2 +/- 0.4. After the initial treatment by BICAP, radiotherapy or radiochemotherapy were respectively associated in 4 and 10 patients. The median duration of improvement was significantly longer in patients who underwent radiochemotherapy as compared with patients treated by BICAP alone (22 weeks versus 4 weeks). During the follow-up, 9 patients required several BICAP treatments and at the end of their disease, 12 patients underwent other palliative procedures. Major complications occurred in 4 cases (2 esotracheal fistulas, 1 hemorrhage, and 1 aspiration pneumonia) and mortality related to the procedure was 8%.
Palliative BICAP treatment of obstructing esophageal and cardial cancer provide quick relief of dysphagia but repeated treatment sessions are necessary to maintain initial improvement. The procedure requires a short hospitalization stay and can be easily accomplished in all cases regardless of the tumor features.
目的、患者与方法：本研究的目的是评估姑息性双极电凝探头（BICAP）治疗26例非手术性梗阻性食管癌患者的效果。肿瘤平均长度为7.2厘米。狭窄部位如下：颈段食管3例，胸段食管8例，食管远段三分之一处13例，2例同时累及颈段和胸段食管。大多数病变为环形（73%对27%非环形）和外生性（78%对22%黏膜下）。在直视内镜控制下向前进行电凝。根据实现的 reopening 程度（直径12毫米的内镜能轻松通过）和良好的功能结果（吞咽困难改善，使用标准分级量表从0到4评分，持续超过15天）评估治疗的成功与否。
26例患者共接受了45次BICAP治疗（31次初始治疗，14次重复治疗）。92%的病例实现了 reopening，85%获得了良好的功能结果（治疗前吞咽困难平均评分为3.2，治疗后为1.1）。吞咽困难的改善使21例患者的总体表现状态显著改善，体重稳定或增加。获得良好初始结果所需的平均治疗次数为1.2 +/- 0.4。在BICAP初始治疗后，分别有4例和10例患者接受了放疗或放化疗。与仅接受BICAP治疗的患者相比，接受放化疗的患者改善的中位持续时间显著更长（22周对4周）。在随访期间，9例患者需要多次BICAP治疗，在疾病末期，12例患者接受了其他姑息性手术。4例发生了严重并发症（2例食管气管瘘、1例出血和1例吸入性肺炎），与手术相关的死亡率为8%。
姑息性BICAP治疗梗阻性食管癌和贲门癌可迅速缓解吞咽困难，但需要重复治疗以维持初始改善。该手术住院时间短，无论肿瘤特征如何，在所有病例中都能轻松完成。
