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目的:探讨支架置入后加放疗治疗中晚期食管癌的临床效果及其并发症的防治。方法:22例中晚期食管癌放疗前先在X线监视下置入国产镍钛合金记忆支架,5d～7d后给予放疗。21例采取常规分割放疗,DT1.8Gy～2.0Gy/次,1次/d,5d/周,总量DT40Gy～60Gy/4周～6周。1例采取前程常规分割,后程加速超分割放疗,前程每次DT2Gy,总量DT32Gy,后程加速超分割DT1.5Gy/次,2次/d,2次照射间隔时间≥6h,总DT11.5Gy。结果:22例患者支架全部顺利置放,患者吞咽困难均得到缓解,放疗后22例疗效稳定期平均8个月;带架放疗放射性食管炎较单纯放疗发生早,症状重,经对症治疗均能耐受。结论:晚期食管癌金属支架置入能快速而持久地缓解吞咽困难,改善经口肠内营养,提高生存质量,放射治疗提高了局部控制率,二者结合成为一种有价值的综合治疗措施。建议支架置入后行CT扫描并应用三维治疗计划系统做支架空腔修正制定治疗计划,以减少并发症的发生。
Objective: To investigate the clinical effect and prevention and treatment of advanced esophageal cancer after stent implantation and radiotherapy. Methods: Twenty-two patients with advanced esophageal cancer underwent radiosurgery before the radiotherapy under X-ray monitoring. Twenty-one patients underwent routine radiotherapy, DT1.8Gy ~ 2.0Gy / time, once / d, 5d / week and total DT40Gy ~ 60Gy / 4 weeks ~ 6 weeks. One case took the routine routine division and the later stage accelerated hyperfractionated radiotherapy. The course of each DT2Gy, the total amount of DT32Gy, the later accelerated hyperfractionation of DT1.5Gy / time, 2 times / d, the time of 2 times irradiation ≥6h, the total DT11. 5Gy. Results: Twenty-two patients were placed successfully and the dysphagia was alleviated. Twenty-two patients were stable with an average of 8 months after radiotherapy. Radioactive esophagitis with radiotherapy was earlier than radiotherapy alone. Symptomatic treatment Tolerance. Conclusion: The stenting of advanced esophageal cancer metal stent can quickly and permanently relieve dysphagia, improve enteral nutrition and improve the quality of life, and radiotherapy improves the local control rate. The combination of the two can be a valuable comprehensive treatment. Proposed stent implantation CT scan and the application of three-dimensional treatment planning system to do stent cavity revision treatment plan to reduce the incidence of complications.