探条扩张联合光动力疗法及局部化疗治疗食管贲门癌性狭窄_医学论文.docVIP

探条扩张联合光动力疗法及局部化疗治疗食管贲门癌性狭窄_医学论文 探条扩张联合光动力疗法及局部化疗治疗食管贲门癌性狭窄_医学论文 【摘要】 目的 评价经内镜探条扩张术联合光动力疗法（PDT）及局部化疗治疗食管贲门癌性狭窄的临床疗效。方法 食管贲门癌患者91例，按治疗方法分为对照组（PDT联合局部化疗）和联合扩张治疗组（经内镜探条扩张联合PDT及局部化疗）。所有病例以3～5 mg/kg剂量的血啉甲醚静脉滴注，用药后3 h内于肿瘤病变处注射化疗药物（5-Fu）并激光照射。联合扩张治疗组41例在以上治疗前3天内进行经内镜探条扩张治疗。结果 联合扩张治疗组吞咽困难缓解率显著高于对照组。近期疗效及平均生存期2组间无显著差异。结论 经内镜扩张术联合PDT及局部化疗可显著改善食管贲门癌性狭窄临床症状。 【关键词】 光动力疗法 局部化疗 探条扩张 食管贲门癌 癌性狭窄 Abstract：Objective To evaluate the effect of endoscopic splender dilation combined with photodynamic therapy（PDT） and local chemotherapy in treatment of esophagocadial cancer stenosis.Methods 91 patients with advanced esophagocadial cancer were divided into two groups: the control group (to receive PDT and local chemotherapy) and the test group (to receive endoscopic splender dilation plus PDT and local chemotherapy). All of the patients were given local injection of chemical drug （5-Fu） and laser irradiation within three hours after intravenous injection of hermimether 3～5 mg/kg. In the 41 patients of test group, endoscopic splender dilation was carried out three days before local chemotherapy and PDT.Results The rate of dysphagia remission was higher in the test group than in the control group, but no significant differences were found in short term efficacy and average survival time between the two groups.Conclusion Endoscopical splender dilation combined with photodynamic therapy and local chemotherapy is effective in alleviating the patients′ symptom of esophagocadial cancer stenosis. Key words: photodynamic therapy； local chemotherapy； Gilliard dilation； esophagocardial cancer； cancer stenosis 食管贲门狭窄是中晚期食管贲门癌患者的主要表现，并严重影响患者生活质量及生存期。随着内镜技术的发展，可采用内镜下探条扩张、微波治疗、记忆合金支架置放术进行治疗，对不能手术治疗者均取得较好的近期疗效，但对控制疾病本身的进展并无益处。自2002年1月至2007年12月，我院以经内镜探条扩张术联合光动力疗法（photodynamic therapy， PDT）及局部化疗治疗食管贲门癌性狭窄取得较好效果，现报道如下。 1 资料和方法 1.1 病例资料 食管贲门癌患者91例，均有不同程度吞咽困难及体重减轻，所有病例均经内镜检查和活检病理确诊。吞咽困难分级参照Stooler分级［1］（0级：无症状，能正常进食；Ⅰ级：能进软食；Ⅱ级：能进半流质饮食；Ⅲ级：仅能进流质饮食；Ⅳ级：不能进食，水也不能咽下）。按治疗方法分为2组，即对照组：PDT联合局部化疗；联合扩张治疗组：经内镜探条扩张治