125I粒子覆膜支架、常规自膨式支架治疗复杂性食管癌性狭窄的比较

摘要

目的 探讨并对比125I粒子覆膜支架、常规自膨式支架治疗复杂性食管癌性狭窄的效果.方法 将151例行支架置入治疗的复杂性食管癌性狭窄患者根据置入支架类型分为2组,63例采用国产覆膜高弹力记忆合金食管内支架作为普通组,88例采用携带125I粒子的国产覆膜高弹力记忆合金食管内支架作为粒子组,比较2组术前、术后1周吞咽困难程度,比较2组术前及术后6个月体重、白蛋白,并根据欧洲癌症研究与治疗组织(EORTC)食管癌患者补充量表(QLQ-OES18)评估患者生活质量,比较2组并发症发生率;随访至2017年7月,记录中位生存时间.结果 2组术后1周吞咽困难Stooler分级均为0Ⅰ级(P＞ 0.05).普通组术后6个月体重、白蛋白水平低于粒子组,术后6个月吞咽困难、进食评分高于粒子组,差异有统计学意义(P ＜0.05);普通组术后再狭窄率(41.27％)高于粒子组(20.45％),差异有统计学意义(P ＜0.05).粒子组中位生存时间为10.1个月,普通组生存时间为8.9个月,差异有统计学意义(P ＜0.05).结论 2种支架在解除复杂性食管癌性狭窄患者吞咽困难上的短期效果一致;但与常规自膨式支架相比,125I粒子支架在降低术后复发率、延长中位生存时间上更具优势.%Objective To investigate and compare the effects of125I seed covered stent and conventional self-expanding stent in the treatment of complex malignant esophageal stricture. Methods 151 patients with complicated malignant esophageal stricture treated by stent implantation were divided into 2 groups according to the type of implanted stent. 63 patients treated with domestic covered high-elasticity memory alloy esophagus stent were included in the normal group while 88 patients treated with domestic covered high-elasticity memory alloy esophagus stent with125I seed were included in the seed group. The degree of dysphagia was compared between the 2 groups before operation and at 1 week after operation. Weight and albumin levels were compared between the 2 groups before operation and at 6 months after operation. The quality of life was evaluated with the European Organisation for Research and Treatment of Cancer (EORTC) scale for patients with esophageal cancer (QLQ-OES18), and the incidence of complications was compared between the 2 groups. All patients were followed up to July 2017, and the median survival time was recorded. Results Stooler grades of dysphagia were grade 0 ～ Ⅰ in 2 groups at 1 week after operation (P＞ 0. 05).The weight, albumin levels, scores of dysphagia and taking food in the normal group at 6 months after operation were higher than those in the seed group (P ＜ 0. 05). The incidence of re-stricture in the normal group (41. 27％) was higher than that in the seed group (20. 45％) (P ＜ 0. 05). The median survival time of the seed group and the normal group was 10. 1 months and 8. 9 months, respectively (P ＜ 0. 05). Conclusion Effects of the 2 kinds of stents are the same in relieving dysphagia in patients with complex malignant esophageal stricture. Compared with conventional self-expanding stent, 125I seed peritoneal stent has more advantages in reducing postoperative recurrence rate and prolonging the median survival time.