关键词: 食管肿瘤, 内镜治疗, 金属支架, 放射性粒子支架

Abstract:

Objective To explore the efficacy and safety of treating advanced esophageal cancer by implanting the common stent and the radioactive ¹²⁵I particle stent with endoscope. Methods The clinical data of patients with advanced esophageal cancer admitted to Jingbian County People's Hospital of Shaanxi Province，the First Affiliated Hospital of Xi'an Medical University，Xijing Hospital of Digestive Diseases of Air Force Medical University and the First Hospital of Yulin of Shaanxi Province from December 2014 to December 2020 were retrospectively analyzed. Patients were divided into common stent group （n=66） and radioactive particle stent group （n=34） according to different stent types. The postoperative complications，Karnofsky performance status （KPS） score，dysphagia score，restenosis rate and quality of life were compared between the two groups. Results The incidences of postoperative retrosternal pain in the common stent group and the radioactive particle stent group were 65.2% （43/66） and 47.1% （16/34） respectively. The incidences of pharyngeal pain and hoarseness were 12.1% （8/66） and 5.9% （2/34）. The incidences of abdominal pain were 9.1% （6/66） and 2.9% （1/34）. The incidences of errhysis were 3.0% （2/66） and 2.9% （1/34）. The incidences of vomiting and nausea were 7.6% （5/66） and 5.9% （2/34） respectively. There were no statistically significant differences between the two groups （χ²=3.04，P=0.081； χ²=0.40，P=0.527； χ²=0.53，P=0.467； χ²<0.01，P>0.999； χ²<0.01，P>0.999）. In the two groups，KPS scores in the first，second，third and sixth month after operation were higher than those before operation （all P<0.05）. KPS scores of the radioactive particle stent group in the second，third and sixth month were significantly higher than those of the common stent group [（89.73±7.84） points vs. （82.37±7.42） points，t=4.62，P<0.001； （93.63±8.13） points vs. （88.33±7.28） points，t=3.74，P<0.001； （92.78±6.26） points vs. （87.28±8.73） points，t=3.77，P<0.001]. The dysphagia scores of patients in the two groups in the first，second，third and sixth month were lower than those before operation （all P<0.05）. The dysphagia scores of the radioactive particle stent group in the third and sixth month after operation were significantly lower than those of the common stent group [（0.68±0.12） points vs. （2.33±0.32） points，t=26.20，P<0.001； （0.82±0.22） points vs. （2.67±0.24） points，t=36.92，P<0.001]. In the third month after operation，the restenosis rate of the radioactive particle stent group was significantly lower than that of the common stent group [5.88% （2/34） vs. 42.4% （28/66），χ² =14.27，P<0.001]. The scores of QLQ-C30 and OES-18 scales in the first，second，third and sixth month after operation were lower than those before operation （all P<0.05）. The scores of QLQ-30 scale in the radioactive particle stent group in the second，third and sixth month were significantly lower than those in the common stent group [（19.12±3.02） points vs. （21.22±2.87） points，t=3.39，P=0.001； （15.04±1.68） points vs. （20.43±2.23） points，t=12.39，P<0.001； （14.38±2.18） points vs. （19.77±3.67） points，t=9.20，P<0.001]. The scores of OES-18 scale in the radioactive particle stent group were also significantly lower than those in the common stent group [（17.13±2.07） points vs. （20.64±2.11） points，t=7.95，P<0.001； （15.22±1.88） points vs. （19.24±1.76） points，t=10.62，P<0.001； （14.74±2.36） points vs. （18.53±3.27） points，t=6.01，P<0.001]. Conclusion The radioactive particle stent can improve the quality of life of patients with advanced esophageal cancer with esophageal stenosis，so as to improve dysphagia and reduce the restenosis rate after operation. However，whether it is obviously superior to common stent in prolonging survival time and reducing complications needs to be further confirmed by a multicenter，prospective，large-sample randomized controlled study.

Key words: Esophageal neoplasms, Endoscopic treatment, Mental stent, Radioactive particle stent