联合食管支架置入与胃造瘘建立恶性食管梗阻肠内营养通路的建立
Establishment of an enteral nutrition pathway for malignant esophageal obstruction using combined esophageal stenting and gastrostomy.
文献信息
| PMID | 42928134 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Wennan Huang |
| 作者单位 | Endoscopy Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China. |
| 期刊 | BMC gastroenterology |
| SCI 分区 | Q2 |
| IF | 3.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 晚期食管癌患者营养不良常见，并与不良结局相关。虽然食管支架可缓解吞咽困难，但单纯经口进食往往不足。经皮内镜下胃造瘘（PEG）可提供可靠的营养支持，但不能解决梗阻症状。关于联合使用这些方法的数据有限。
方法： 我们回顾性分析了2016年1月至2024年12月期间接受食管支架置入联合PEG治疗的16例食管癌患者，其中10例接受同期手术，6例接受非同期手术。分析从基线至治疗后1个月血清白蛋白、血红蛋白和Karnofsky体能状态（KPS）评分的变化。
结果： 平均年龄为63.13±10.36岁，75.0%的患者为男性。肿瘤位于上、中、下食管者分别占18.8%、50.0%和31.3%，37.5%存在食管瘘。从诊断到联合内镜治疗的中位间隔为131.5天（四分位距20.8-389.8天）。所有患者均获得技术成功，无操作相关出血或胃造瘘部位感染。在非同期组中，两次操作之间的中位间隔为6.5天（范围2-177天）。治疗后30天内新发或加重的肺部感染发生于12.5%的患者。随访期间，支架移位和再狭窄分别发生于12.5%和6.3%的患者。治疗后1、3和6个月时，分别有93.8%、56.3%和18.8%的患者存活。在15例具有基线和1个月配对评估的患者中，两个时间点的血清白蛋白水平分别为33.65±4.51和34.43±4.89 g/L，血红蛋白水平分别为103.93±23.08和106.73±22.01 g/L，Karnofsky体能状态评分分别为70（60-85）和70（65-80）。在血清白蛋白、血红蛋白或Karnofsky体能状态评分的变化方面，未观察到组间差异有统计学意义（均P>0.05）。
结论： 联合食管支架置入与PEG在晚期食管癌合并恶性食管梗阻患者中技术可行，可在建立肠内营养通路的同时缓解梗阻。这种联合策略可作为姑息治疗的一种选择，但其对营养和功能结局的影响仍需进一步研究。
英文摘要
BACKGROUND: Malnutrition is common in patients with advanced esophageal cancer and is associated with poor outcomes. While esophageal stenting can relieve dysphagia, oral intake alone is often insufficient. Percutaneous endoscopic gastrostomy (PEG) provides reliable nutritional support but does not address obstructive symptoms. Data on the combined use of these approaches are limited.
METHODS: We retrospectively analyzed 16 patients with esophageal cancer who underwent combined esophageal stenting and PEG between January 2016 and December 2024, including 10 who underwent simultaneous procedures and 6 who underwent non-simultaneous procedures. Changes in serum albumin, hemoglobin, and Karnofsky Performance Status (KPS) scores from baseline to 1 month after treatment were analyzed.
RESULTS: The mean age was 63.13 ± 10.36 years, and 75.0% of the patients were male. Tumors were located in the upper, middle, and lower esophagus in 18.8%, 50.0%, and 31.3% of patients, respectively, and 37.5% had an esophageal fistula. The median interval from diagnosis to combined endoscopic treatment was 131.5 days (interquartile range, 20.8-389.8 days). Technical success was achieved in all patients, with no procedure-related bleeding or gastrostomy-site infection. In the non-simultaneous group, the median interval between the two procedures was 6.5 days (range, 2-177 days). New or worsening pulmonary infection within 30 days after treatment occurred in 12.5% of patients. During follow-up, stent migration and restenosis occurred in 12.5% and 6.3% of patients, respectively. At 1, 3, and 6 months after treatment, 93.8%, 56.3%, and 18.8% of patients were alive. Among the 15 patients with paired assessments at baseline and 1 month, serum albumin levels were 33.65 ± 4.51 and 34.43 ± 4.89 g/L, hemoglobin levels were 103.93 ± 23.08 and 106.73 ± 22.01 g/L, and Karnofsky Performance Status scores were 70 (60-85) and 70 (65-80) at the two time points. No statistically significant between-group differences were observed in the changes in serum albumin, hemoglobin, or Karnofsky Performance Status scores (all P > 0.05).
CONCLUSIONS: Combined esophageal stenting and PEG was technically feasible in patients with advanced esophageal cancer and malignant esophageal obstruction, providing relief of obstruction while establishing enteral nutrition access. This combined strategy may be considered an option for palliative treatment, although its effects on nutritional and functional outcomes require further investigation.