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目的探讨治疗晚期食管癌吞咽困难有效的治疗模式。方法回顾了在肿瘤中心治疗超过5年时间内所有食管癌患者的临床资料,对所有针对恶性吞咽困难接受姑息治疗的患者进行了数据统计,采用Wilcoxon符号秩检验,以确定意义(P<0.05)。结果 80例不能手术的食管癌患者吞咽困难的行姑息治疗。主要治疗方式是放射治疗,占患者总数的66%,金属支架置入占21%和放疗结合支架占13%。治疗平均时间:支架置入组为1d,放射治疗组为40d(P=0.001)。最初由支架治疗的患者,82%的患者吞咽困难在治疗2周之内改善(吞咽困难评分为0或1),18%的患者在10周的治疗后复发吞咽困难。在放射治疗组,缓解发病较慢,只有50%的患者在第2周得到满意的缓解(吞咽困难评分0或1),缓解无复发的效果稳定,在10周90%的患者吞咽困难评分为0或1。放射治疗和金属支架置入联合治疗组,吞咽困难指数达到1或0的患者,在第2周就占86%;到第10周,吞咽困难指数1或0的患者占92%。结论对于不能手术的食管癌患者,放射治疗可提供持久的吞咽困难缓解效果,但治疗时间偏长和达到满意缓解的时间较为滞后。另一方面,支架提供更迅速和更有效的及时缓解,但难以长期保持。放射治疗和金属支架置入相联合,可以加快缓解时间并达到稳定缓解的效果。
Objective To investigate the effective treatment of dysphagia in advanced esophageal cancer. Methods The clinical data of all patients with esophageal cancer who were treated at the cancer center for more than 5 years were retrospectively analyzed. All patients undergoing palliative treatment for malignant dysphagia were enrolled in the statistical analysis. Wilcoxon signed-rank test was used to determine the significance (P <0.05) . Results 80 cases of inoperable esophageal cancer patients with dysphagia palliative treatment. The main treatment is radiation therapy, accounting for 66% of the total number of patients, metal stent placement accounted for 21% and radiotherapy combined stent 13%. The mean duration of treatment was 1 d in the stenting group and 40 days in the radiotherapy group (P = 0.001). Of the patients initially treated with stents, dysphagia improved in up to two weeks (dysphagia score 0 or 1) in 82% of patients and in 18% of patients relapsed after 10 weeks of treatment. In the radiotherapy group, the onset of remission was slower and only 50% of patients were satisfactorily relieved at week 2 (dysphagia score 0 or 1), the effect of relieving non-recurrence was stable, and 90% of patients at 90 weeks had a dysphagia score of 0 or 1. Radiotherapy and metal stents were included in the combination therapy group with 86% of patients having a swallowing difficulty index of 1 or 0 by week 2, and 92% of patients with a swallowing difficulty index of 1 or 0 by week 10. Conclusions Radiation therapy provides long-lasting relief of dysphagia in patients with esophageal cancer who are inoperable, but treatment time is long and time to satisfactory satisfaction lags behind. Stents, on the other hand, provide more immediate and effective relief in time but are difficult to maintain over the long term. Radiation therapy and metal stent placement combined, can speed up the remission time and achieve stable relief effect.