進行・再発胸部食道癌症例に対するステント治療成績  [in Japanese] Outcome of Stent Placement for Advanced and Recurrent Thoracic Esophageal Cancer  [in Japanese]

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Abstract

切除不能食道癌症例における食道・気道狭窄あるいは瘻孔形成はその予後およびquality of life(以下,QOL)を著しく低下させる要因となる.現在,これらの症例に対してQOL向上を目的にステント留置術が広く行われている.そこで,当科で施行した胸部食道癌に対する食道・気管ステント留置術の成績を検討した.対象と方法:1995年から2003年までにステント治療を施行した食道癌61症例を対象とした.内訳は食道ステント:36例,気管・気管支ステント:17例,食道と気管・気管支のダブルステント留置8例である.食道ステント留置は化学放射線療法(以下,CRTxと略記)後の最終治療として施行したが,気管・気管支ステント症例のうち7例ではステント留置後にCRTxを施行した.これらの症例における予後,経口摂取状況を含むQOLについて検討した.結果:ステント留置後の平均生存期間は,食道ステント例で2.5か月,気管・気管支ステント例で9.6か月,ダブルステント例で3.4か月であった.食道ステント症例の80%で経口摂取が改善し,半数の症例が在宅療養が可能となった.また,ステント留置前にPS3であった17例のうち3例ではステント留置によりPSがさらに悪化した.気管・気管支ステント症例では17例中15例で呼吸状態改善によりPSならびにQOLも向上し,ステント留置後のCRTx奏効例では長期生存も認めた.考察:進行食道癌に対する食道ステント留置はPS1〜2の症例では経口摂取が増加しQOL改善が期待できるが,PS3症例では必ずしもQOL改善にはつながらない.気管・気管支ステント症例では概ねQOLは向上し,CRTxが奏功した症例では長期予後も期待できる.

Malignant strictures and fistula of the esophagus and tracheobronchus adversely affect the quality of life (QOL) and prognosis in patients with incurable esophageal carcinoma. Stenting is one of the best palliation modalities for improve QOL. We evaluated the effect of intraesophageal and intratracheal stenting in patients with stricture and/or fistula of esophagus and trachea due to thoracic esophageal carcinoma. Patients and Methods: Subjects were 61 with advanced esophageal carcinoma treated with stenting from 1995 through 2003, 36 with esophageal stent, 17 with tracheal stent, and 8 with both. They were evaluated based on the prognosis and QOL. An esophageal stent was placed as final treatment after chemoradiation therapy, and 7 out of those treated with the bronchial stent underwent chemoradiation therapy after stenting. Results: Median survival after stenting was 2.5 months in patients with an esophageal stent, 9.6 months in patients with a tracheal stent, and 3.4 months in patients treated with both stents. Food ingestion was improved in 80% of patients with the esophageal stent, and about half were discharged. Worsening of performance status (PS) was seen after stenting in 3 out of 17 patients with PS3. Tracheal stent placement improved the PS in 15 out of 17 patients, resulting in the improvement of the QOL. Responders for chemoradiation therapy after trachial stenting survived for a long time. Conclusions: Esophageal stenting improved food ingestion and QOL in patients with PS≦2. It did not always result in improved QOL in those patients with PS3. QOL improved in most of patients treated with the trachial stents, and long survival is expected in responders to chemoradiation therapy after stenting.

Journal

  • The Japanese journal of gastroenterological surgery

    The Japanese journal of gastroenterological surgery 39(9), 1465-1471, 2006-09-01

    The Japanese Society of Gastroenterological Surgery

References:  16

Cited by:  4

Codes

  • NII Article ID (NAID)
    110004793264
  • NII NACSIS-CAT ID (NCID)
    AN00192066
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    03869768
  • Data Source
    CJP  CJPref  NII-ELS 
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