摘要
目的探讨影响食管癌伴食管瘘患者的预后因素,并评价胃管植入、食管覆膜支架植入和胃造瘘术行营养支持的应用价值。方法回顾性分析2011年1月至2019年12月124例食管癌伴食管瘘患者的临床资料,其中42例行胃造瘘术、41例行食管覆膜支架植入、41例行胃管植入,所有患者均给予营养支持。比较3种营养方式应用前后血红蛋白(Hb)、白蛋白(ALB)和体质量指数(BMI)的差异。生存分析采用Kaplan-Meier法,影响总生存时间(OS)的多因素分析采用Cox比例风险回归模型。结果仅胃造瘘术后Hb和ALB的均值均高于治疗前(P<0.05),3种介入治疗前后BMI均值的差异均无统计学意义(P>0.05)。经治疗,40例患者瘘口愈合,瘘口愈合者中有10例继续行抗肿瘤治疗。全组患者发生瘘后的OS为0.2~36个月,中位OS为4个月,1、2年生存率分别为12.1%和0.8%。行胃造瘘术、食管覆膜支架植入和胃管植入患者的中位OS分别为7.0、4.0和3.2个月。单因素分析显示,性别、食管瘘分型和瘘后营养方式与OS有关(P<0.05);Cox多因素分析显示,性别和瘘后营养方式是影响食管癌伴食管瘘患者OS的独立因素(P<0.05)。结论食管癌伴食管瘘患者行胃造瘘术可保证患者营养摄入和改善体质,优于食管覆膜支架植入和胃管植入。
Objective To evaluate the prognostic factors of patients with esophageal cancer with esophageal fistula,and to evaluate the application value of gastric tube placement,esophageal covered-stent placement and gastrostomy.Methods The clinical data of 124 patients with esophageal cancer with esophageal fistula from January 2011 to December 2019 were collected,including 42 patients with gastrostomy,41 patients with esophageal covered-stent placement,and 41 patients with gastric tube placement.The differences of hemoglobin(Hb),serum albumin(ALB)and body weight index(BMI)were compared before and after application of the three nutritional support patterns.Kaplan-Meier method was used to analyze overall survival(OS),and factors affecting OS were performed by Cox proportional hazard model.Results The level of Hb and serum ALB raised only in gastrostomy group after treatment(P<0.05),while the differentiation of BMI was not significant(P<0.05).After treatment,the fistula was healed in 40 paitents,among whom 10 patients continued anti-cancer treatment.In the whole group,the total survival time was 0.2-36 months after esophageal fistula,the median OS was 4 months,and the 1-,2-year survival rates after esophageal fistula were 12.1%and 0.8%,respectively.The median OS of patients underwent gastrostomy,esophageal covered-stent placement and gastric tube placement was 7.0,4.0 and 3.2 months.Univariate analysis showed that gender,esophageal fistula types and nutritional support patterns after esophageal fistula were related to OS(P<0.05).Cox multivariate analysis showed that gender and nutritional support patterns after esophageal fistula were independent factors influencing OS(P<0.05).Conclusion Gastrostomy can ensure the patients'nutritional intake and body improvement,which is better than gastric tube placement and esophageal covered-stent placement.
作者
徐文静
江宁
张倩
徐清宇
尹国文
钱普东
XU Wenjing;JIANG Ning;ZHANG Qian;XU Qingyu;YIN Guowen;QIAN Pudon(Department of Oncology, People's Hospital of Xinghua, Xinghua 225700, China)
出处
《临床肿瘤学杂志》
CAS
北大核心
2020年第11期999-1004,共6页
Chinese Clinical Oncology
关键词
食管癌
食管瘘
胃管植入
食管覆膜支架植入
胃造瘘术
营养支持
Esophageal cancer
Esophageal fistula
Gastric tube placement
Esophageal covered-stent placement
Gastrostomy
Nutritional support
