Wax M K, Amirali A, Ulewicz D E, Lough R
Department of Otolaryngology, West Virginia University, Morgantown, USA.
Ann Otol Rhinol Laryngol. 1997 Apr;106(4):297-300. doi: 10.1177/000348949710600406.
Carcinoma of the esophagus is a disease with a poor prognosis. Surgery is considered the treatment of choice. Patients who are surgically unresectable may receive radiotherapy, plus or minus chemotherapy. While this offers reasonable palliation, a significant number of patients develop benign or malignant strictures. Frequent esophagoscopy with dilation is required if they are to swallow. Patients with strictures or malignancy of the esophagus are more prone to complications if they undergo an esophagoscopy. We examined the morbidity of esophagoscopy in a group of patients who had received radiotherapy for carcinoma of the esophagus. Over a 10-year period, 21 patients receiving irradiation for carcinoma of the esophagus were examined. All patients underwent esophagoscopy for staging and diagnosis. The tumor locations were upper (6), middle (6), and lower (9) esophagus. The T-stages were 1 (7), 2 (6), 3 (6), and 4 (2). Five patients had dilation of a malignant stricture at the time of diagnosis. Fever developed and resolved within 24 hours in 2 patients. Following completion of irradiation, a total of 83 esophagoscopies were performed (range 1 to 11 per patient). Six patients with no tumor or stricture underwent 8 esophagoscopies (3 rigid, 5 flexible). There was 1 episode of minimal bleeding and 1 fever that resolved within 24 hours. Ten patients with malignant strictures underwent 62 esophagoscopies (5 rigid, 57 flexible). There were 17 (27%) episodes of fever (all resolved within 24 hours) and 14 (22%) episodes of bleeding. Five patients with benign strictures underwent 13 esophagoscopies (2 rigid, 11 flexible). One patient had a perforation that resolved with conservative treatment, and 1 patient developed an epidural abscess 2 months following dilation. This patient is the only one that required surgical intervention and had prolonged hospitalization. Esophagoscopy of the irradiated esophagus can be performed relatively safely and excellent palliation obtained. Morbidity consisting of minimal bleeding, and fever lasting less than 24 hours, is frequent but self-limited.
食管癌是一种预后较差的疾病。手术被认为是首选的治疗方法。无法进行手术切除的患者可接受放疗，联合或不联合化疗。虽然这能提供合理的姑息治疗，但仍有相当数量的患者会出现良性或恶性狭窄。如果要吞咽，就需要频繁进行食管镜检查并扩张。患有食管狭窄或恶性肿瘤的患者进行食管镜检查时更容易出现并发症。我们检查了一组接受食管癌放疗的患者进行食管镜检查的发病率。在10年期间，对21例接受食管癌放疗的患者进行了检查。所有患者均接受食管镜检查以进行分期和诊断。肿瘤位于食管上段（6例）、中段（6例）和下段（9例）。T分期为1期（7例）、2期（6例）、3期（6例）和4期（2例）。5例患者在诊断时对恶性狭窄进行了扩张。2例患者出现发热，并在24小时内消退。放疗结束后，共进行了83次食管镜检查（每位患者1至11次）。6例无肿瘤或狭窄的患者进行了8次食管镜检查（3次硬质，5次软质）。有1次轻微出血事件和1次发热，在24小时内消退。10例患有恶性狭窄的患者进行了62次食管镜检查（5次硬质，57次软质）。有17次（27%）发热事件（均在24小时内消退）和14次（22%）出血事件。5例患有良性狭窄的患者进行了13次食管镜检查（2次硬质，11次软质）。1例患者出现穿孔，经保守治疗后痊愈，1例患者在扩张后2个月出现硬膜外脓肿。该患者是唯一需要手术干预且住院时间延长的患者。对接受放疗的食管进行食管镜检查相对安全，且能获得良好的姑息治疗效果。由轻微出血和持续时间少于24小时的发热组成的发病率较高，但具有自限性。
