摘要
目的观察食管癌合并食管狭窄患者行球囊扩张联合支架植入术前、后食管狭窄段直径、饮食与营养状况及术后并发症发生情况,探讨其疗效及安全性。方法食管癌合并食管狭窄患者72例,其中行球囊扩张联合支架植入术者36例为观察组,行单纯球囊扩张术者36例为对照组,比较2组术后2个月食管狭窄治疗总有效率、扩张次数及并发症发生情况,比较2组术前及术后2个月食管狭窄段直径、吞咽困难分级、食管癌专用生活质量量表评分(包括进食不适、吞咽梗阻、吞咽唾液困难、吞咽功能4个维度)及血红蛋白、血清白蛋白和转铁蛋白水平。结果观察组术后2个月食管狭窄治疗总有效率(100.00%)高于对照组(83.33%)(χ2=4.546,P=0.033),扩张次数[(1.16±0.08)次]少于对照组[(1.72±0.26)次](t=12.351,P<0.001),并发症总发生率(16.67%)与对照组(11.11%)比较差异无统计学意义(χ2=0.465,P=0.496)。观察组术后2个月食管狭窄段直径[(14.09±1.75)mm]大于对照组[(12.25±1.17)mm](t=4.435,P<0.001),吞咽困难分级低于对照组(Z=2.744,P=0.006),血红蛋白[(123.12±7.59)g/L]、血清白蛋白[(36.27±2.49)g/L]和转铁蛋白[(2.21±0.39)g/L]水平及吞咽功能评分[(46.86±6.94)分]均高于对照组[(118.37±6.72)g/L、(34.63±2.08)g/L、(1.86±0.35)g/L、(42.23±5.76)分](P<0.05),进食不适、吞咽梗阻、吞咽唾液困难评分[(23.95±4.82)、(30.39±6.35)、(29.67±6.05)分]均低于对照组[(30.76±5.94)、(38.47±7.68)、(38.40±6.78)分](P<0.05);观察组术前以上指标与对照组比较差异均无统计学意义(P>0.05);2组术后2个月食管狭窄段直径均大于术前(P<0.05),吞咽困难分级及进食不适、吞咽梗阻、吞咽唾液困难评分均低于术前(P<0.05),血红蛋白、血清白蛋白、血清转铁蛋白水平及吞咽功能评分均高于术前(P<0.05)。结论食管癌合并食管狭窄患者采用球囊扩张联合支架植入术治疗可明显增加食管狭窄段直径,改善饮食、营养状况及生活质量,减少扩张次数,安全性良好。
Objective To observe the diameter of esophageal stricture, the diet and nutritional status before and after balloon dilation plus stent implantation, and postoperative complications in patients with esophageal cancer complicated with esophageal stricture, and to investigate the efficacy and safety. Methods In 72 patients with esophageal cancer complicated with esophageal stricture, 36 patients underwent balloon dilation plus stent implantation(observation group), and 36 patients underwent balloon dilatation(control group). The total effective rate, frequency of dilation and incidence of complications were compared between two groups two months after operation.The diameter of esophageal stricture segment, dysphagia grade, quality of life questionnaire for esophageal cancer(eating discomfort, swallowing obstruction, difficulty swallowing saliva, 4 dimensions of swallowing), and levels of hemoglobin, serum albumin and transferrin were compared between two groups before operation and two months after operation. Results Two months after operation, the total effective rate of esophageal stricture was higher in observation group(100.00%) than that in control group(83.33%)(χ~2=4.546, P=0.033), the frequency of dilation was less in observation group(1.16±0.08) than that in control group(1.72±0.26)(t=12.351, P<0.001), the incidence of complication showed no significant difference between two groups(16.67% vs. 11.11%)(χ~2=0.465, P=0.496), the diameter of esophageal stricture segment was greater in observation group [(14.09±1.75) mm] than that in control group [(12.25±1.17) mm](t=4.435, P<0.001), the dysphagia grade was lower in observation group than that in control group(Z=2.744, P=0.006), the levels of hemoglobin, serum albumin and transferrin as well as and swallowing function score were lower in observation group [(123.12±7.59) g/L,(36.27±2.49) g/L,(2.21±0.39) g/L, 46.86±6.94] than those in control group [(118.37±6.72) g/L,(34.63±2.08) g/L,(1.86±0.35) g/L, 42.23±5.76](P<0.05), and eating discomfort,swallowing obstruction and difficulty swallowing saliva scores were lower in observation group(23.95±4.82,30.39±6.35,29.67±6.05)than those in control group(30.76±5.94,38.47±7.68,38.40±6.78)(P<0.05).All above indexes showed no significant differences between two groups before operation(P>0.05).Compared with before operation,the diameters of esophageal stricture segment were greater(P<0.05),dysphagia grades,and scores of eating discomfort,swallowing obstruction and difficulty swallowing saliva were lower(P<0.05),and the levels of hemoglobin,albumin and transferrin as well as swallowing function score were higher two months after operation in two groups(P<0.05).Conclusion Balloon dilation plus stent implantation can enlarge the diameter of esophageal stricture segment,improve dietary status,nutritional status and quality of life,and reduce the frequency of dilations in the treatment of esophageal cancer complicated with esophageal stricture,and it has high safety.
作者
顾园园
赵湘
何红梅
GU Yuan-yuan;ZHAO Xiang;HE Hong-mei(Department of Gastroenterology,Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001,China;Department of Thoracic Surgery,Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001,China)
出处
《中华实用诊断与治疗杂志》
2022年第10期1038-1042,共5页
Journal of Chinese Practical Diagnosis and Therapy
关键词
食管癌
食管狭窄
球囊扩张术
支架植入术
狭窄段直径
饮食状况
营养状况
esophageal cancer
esophageal stricture
balloon dilatation
stent implantation
diameter of esophageal stricture segment
dietary status
nutritional status
