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目的评价伴先兆穿孔征象食管癌动脉内灌注化疗的近期疗效、治疗风险和临床应用价值。方法对87例伴先兆穿孔征象食管癌初治患者,采用Seldinger技术进行肿瘤供血靶动脉的选择性插管和造影,并经导管灌注化疗药物。结果87例患者经动脉灌注化疗后近期疗效为完全缓解35例,部分缓解44例,无变化7例,进展1例,总有效率90.8%(79/87)。本组经治疗后,81例(93.1%)溃疡X线征消失。治疗过程中38例(44.0%)患者溃疡消失后出现可逆性食管狭窄,但随治疗次数的增多和病变的恢复变窄的管腔再度增宽。本组1例并发食管穿孔,形成食管-气管瘘而死亡。1例于再次治疗后发生较为严重的药物性食管炎,病变段及正常食管段分别形成食管深溃疡。结论动脉内灌注化疗治疗伴先兆穿孔征象食管癌是一种较好的疗法。但应重视和预防严重并发症的发生。
Objective To evaluate the short-term effect, therapeutic risk and clinical value of intra-arterial infusion chemotherapy for esophageal cancer with threatened perforation. Methods 87 patients with signs of threatened perforation signs of esophageal cancer were treated with Seldinger technique for selective intubation and contrast imaging of the target blood vessels for tumor supply, and chemotherapy was catheterized. Results The immediate curative effect of 87 patients after percutaneous arterial infusion chemotherapy was complete remission in 35 cases, partial remission in 44 cases, no change in 7 cases and progression in 1 case. The total effective rate was 90.8% (79/87). After treatment in this group, 81 patients (93.1%) ulcer X-ray sign disappeared. Reversible esophageal stricture was found in 38 patients (44.0%) during the course of treatment. However, with the increase of the number of treatment and the narrowing of the lesion, the lumen was broadened again. The group of 1 case of esophageal perforation, the formation of esophageal-tracheal fistula and died. 1 case occurred again after treatment of more serious medical esophagitis, lesions and normal esophageal segments were formed deep esophageal ulcers. Conclusion Intra-arterial infusion chemotherapy for esophageal cancer with signs of perforation is a better treatment. However, serious complications should be emphasized and prevented.