中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2018, Vol. 47 ›› Issue (5): 439-442.doi: 10.12007/j.issn.0258-4646.2018.05.013

• 论著 • 上一篇    下一篇

食管癌放射治疗中或放射治疗后并发食管穿孔的临床分析

唐玲荣, 李光   

  1. 中国医科大学附属第一医院放射治疗科, 沈阳 110001
  • 收稿日期:2017-07-03 出版日期:2018-05-30 发布日期:2018-04-27
  • 通讯作者: 李光 E-mail:13804058616@163.com
  • 作者简介:唐玲荣(1989-),女,医师,硕士.

Clinical Analysis of Esophageal Perforation during or after Radiotherapy for Esophageal Carcinoma

TANG Lingrong, LI Guang   

  1. Department of Radiotherapy, The First Hospital, China Medical University, Shenyang 110001, China
  • Received:2017-07-03 Online:2018-05-30 Published:2018-04-27

摘要: 目的 分析食管癌患者放射治疗(简称放疗)中及放疗后并发穿孔的相关因素及临床治疗。方法 回顾性分析336例食管癌患者的临床资料,其中22例并发放疗中或放疗后穿孔。采用Fisher检验和logistic回归分析患者并发穿孔的相关因素,总结治疗经验及临床疗效。结果 22例并发穿孔患者中,放疗中穿孔5例,放疗后穿孔17例;气管食管瘘19例,食管纵隔瘘2例,食管胸膜瘘1例;统计分析显示T4为食管癌放疗中、后穿孔的相关危险因素。10例患者给予支架植入术,1例(食管胸膜瘘)行食管内支架植入及胸腔引流术,4例植入胃空肠营养管鼻饲,7例因高龄、重症感染、一般状态差等因素行肠外营养支持。穿孔患者全部死亡,从穿孔至死亡的时间为0.6~6个月,中位生存时间2个月,在穿孔后3个月内死亡者占72.7%。结论 食管癌放疗中或放疗后并发穿孔预后差,在临床治疗中要高度重视T4患者。

关键词: 食管癌, 穿孔, 临床分析

Abstract: Objective To analyze the risk factors and clinical treatment of esophageal perforation during or after radiotherapy (RT) in patients with esophageal carcinoma.Methods Clinical data of 336 patients with esophageal carcinoma were retrospectively analyzed, and esophageal perforation during or after RT were identified in 22 patients. Treatment strategies and effects were investigated. Fisher's exact test and logistic analysis were used to analyze the risk factors.Results Among these 22 patients,5 and 17 developed esophageal perforations during and after RT,respectively. Tracheoesophageal fistula was found in 19 patients,while esophageal mediastinal fistula and esophageal pleural fistula were present in 2 and 1,respectively. Statistical results demonstrated that stage T4 was a risk factor of esophageal perforation associated with RT. Ten patients underwent placement of metallic stents. One patient with esophageal pleural fistula was treated with metallic stent placement and chest drainage. Four patients underwent placement of nasal-gastric tubes and the other 7 received parenteral nutrition support because of old age and severe infection. All 22 patients died approximately 0.6 to 6 months after developing the perforation,with a median survival time of 2 months;72.7% of the patients died within 3 months.Conclusion The prognosis of esophageal perforation is poor and greater attention should be paid to patients in stage T4.

Key words: esophageal carcinoma, perforation, clinical analysis

中图分类号: 

  • R735.1
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