图像引导的光动力治疗改善老年重度梗阻食管癌患者营养状况的研究

• 作者： 张明 ¹ 许静 ¹ 孙振华 ^1，2 赵文浩 ¹ 马樱倩 ¹ 张建桥 ¹ 沈海萍 ¹
• 作者单位：
  1.  050051 河北省石家庄市，河北省人民医院肿瘤科

  2.  063000 河北省唐山市，华北理工大学研究生院
• 提交时间：2023-06-08

摘要: 背景　食管癌（EC）是具有侵袭性的胃肠道癌症之一。晚期食管癌主要与吞咽困难有关。对于重度梗阻的老年食管癌患者，因其多合并基础性疾病，不能耐受麻醉及有创治疗，而短期内吞咽困难无法改善会严重影响患者的营养状况、生活质量及预后。目的　探索局部麻醉下图像引导的光动力治疗（IGPDT）短期改善老年重度梗阻食管癌患者梗阻及营养状况的安全性及有效性。方法　本研究为前瞻性、单臂、自身对照研究，选取 2020 年 3 月2021 年 12 月在河北省人民医院治疗的 24 例重度梗阻老年食管癌患者进行 IGPDT。治疗前通过内镜确定病变上界并用金属组织夹标记，通过 CT 三维重建及造影确定病变下界，激光治疗光纤在 X 线透视引导下送达病变部位进行治疗。术前、术后 1 周和 1 个月评估患者 Stooler 吞咽困难评分。术前及术后 2 个月通过营养风险筛查评分 2002（NRS 2002）、血红蛋白、BMI、白蛋白、前白蛋白变化评估患者营养状态，吞咽生活质量量表（SWAL-QOL）评价患者生存质量。结果　患者术后 1 个月疗效评价均达部分缓解（PR）。患者术后 1 周、1 个月 Stooler 评分均较术前降低（P<0.001）。患者术后 2 个月 BMI、白蛋白、前白蛋白水平较术前升高（P<0.05）。患者术后 2 个月 SWAL-QOL 维度心理负担、食欲、进食时间、进食恐惧、吞咽障碍的评分及总分均较术前升高（P<0.05）。92%（22/24）的患者出现 1~2 级的轻度发热，多数患者可自行缓解；83%（20/24）的患者食管治疗部位会在术后 1~2 d 出现 1~2 级疼痛但可自行缓解。治疗过程中所有患者未发生食管瘘，也未发生 3 级及以上的严重不良反应。结论　IGPDT 操作简便，安全性好，短期内改善患者的营养状况，可作为内镜无法通过的重度梗阻性老年食管癌患者光动力治疗的新方法。

Abstract: Background Esophageal cancer（EC） is one of the most aggressive gastrointestinal tumors.Advanced esophageal carcinoma is mainly associated with dysphagia. Most elderly patients with severe obstruction esophageal carcinomacannot tolerate anesthesia and invasive treatment due to comorbidities，while the failure to improve dysphagia in the short term will seriously affect the nutritional status，life quality and prognosis of patients. Objective To explore the safety and efficacy of image-guided photodynamic therapy （IGPDT） under local anesthesia for short-term improvement of obstruction and nutritional status in elderly patients with severe obstruction esophageal carcinoma. Methods A total of 24 elderly patients with severe obstruction esophageal carcinoma admitted to Hebei General Hospital from March 2020 to December 2021 were selected for IGPDT in the prospective，single-arm，self-control study. The upper boundary of the lesion was located by endoscopyand marked with metal tissue clips，the lower boundary of the lesion was located by CT and esophagography before treatment. During the treatment，the fiber of laser treatment was delivered to the lesion site under the guidance of X-ray fluoroscopy during treatment. The Stooler dysphagia score was evaluated before，1 week and 1 month after operation. The nutritional status of patients was evaluated by nutritional risk screening 2002 score（NRS 2002），hemoglobin，BMI，albumin and prealbumin before and 2 months after operation. The swallowing quality of life scale（SWAL-QOL） was used to evaluate the quality of life in patients. Results All patients achieved partial response（PR） at 1 month postoperative efficacy evaluation. The Stooler dysphagia scores at 1 week and 1 month after IGPDT were significantly lower than that before operation（P<0.001）. BMI，albumin and prealbumin at 2 months after operation were significantly increased than that before operation（P<0.05）. The total score and scores of different dimensions in SWAL-QOL at 2 months after operation were significantly higher than those before operation，including psychological burden，appetite，eating time，fear of eating and dysphagia（P<0.05）. 92%（22/24） of the patients presented with grade 1-2 mild fever，and most of them could be relieved on their own. 83%（20/24） of the patients presented with grade 1-2 pain at the site of operation at 1-2 days after surgery but could be relieved by themselves. No esophageal fistula occurred in all patients during the operation，and no serious adverse effects of grade 3 or above occurred. Conclusion　 IGPDT has the advantages of easy operation，excellent efficacy and safety，and short-term improvement of nutritional status in patients，which can be used as a novel photodynamic therapy for patients with severe obstruction esophageal carcinoma cannot be passed by endoscopy.

• 分类： 医学、药学 >> 基础医学
• 引用： ChinaXiv:202306.00072 (或此版本 ChinaXiv:202306.00072V1)
  DOI:10.12114/j.issn.1007-9572.2023.0188
  CSTR:32003.36.ChinaXiv.202306.00072.V1
• 推荐引用方式： 张明,许静,孙振华,赵文浩,马樱倩,张建桥,沈海萍.(2023).图像引导的光动力治疗改善老年重度梗阻食管癌患者营养状况的研究.中国全科医学.doi:10.12114/j.issn.1007-9572.2023.0188 (点此复制)