CAJ | 학술논문

背景与目的：鼻咽癌好发于我国南方地区，同步放化疗在进展期鼻咽癌中的疗效显著，但同步放化疗的不良反应较单纯放疗显著增加，影响了患者放化疗的顺利进行。目前临床上常用局部对症处理和全身营养支持治疗等方法减轻放疗反应以提高患者治疗耐受性，但收效甚微。本文旨在探讨经皮内镜下胃造瘘术(percutaneous endoscopic gastrostomy，PEG)在进展期鼻咽癌中的应用价值。方法：福建省肿瘤医院2010年10月-2012年6月71例病理证实的初诊鼻咽癌进展期患者，放化疗前行PEG术，放化疗期间行胃造瘘饮食及相关护理，检测放化疗不良反应、治疗耐受性及体重、血清白蛋白等营养指标情况。结果：71例患者行PEG术68例成功，3例失败。剩下的64例患者中51例顺利完成3周方案的同步化疗，同步化疗完成率为79.69%，4例因肝转移或肝功能损害未行同步化疗。所有68例患者体重变化在-11.86%~0.83%内，平均-5.32%±2.99%，前后血清白蛋白配对t检验提示放化疗前后差异无统计学意义(P=0.742)。60.29%(41/68)患者发生Ⅱ度放射性口腔炎，22.06%(15/68)患者发生Ⅲ度放射性口腔炎。结论：对初诊进展期鼻咽癌患者行预防性PEG术提高了患者同步放化疗的耐受性，降低了不良反应，减少了因放化疗不良反应引起的放疗中断时间，提高了同步化疗的完成率，改善了患者的营养状况及生存质量，且简单、经济、易行、安全。
배경여목적：비인암호발우아국남방지구，동보방화료재진전기비인암중적료효현저，단동보방화료적불량반응교단순방료현저증가，영향료환자방화료적순리진행。목전림상상상용국부대증처리화전신영양지지치료등방법감경방료반응이제고환자치료내수성，단수효심미。본문지재탐토경피내경하위조루술(percutaneous endoscopic gastrostomy，PEG)재진전기비인암중적응용개치。방법：복건성종류의원2010년10월-2012년6월71례병리증실적초진비인암진전기환자，방화료전행PEG술，방화료기간행위조루음식급상관호리，검측방화료불량반응、치료내수성급체중、혈청백단백등영양지표정황。결과：71례환자행PEG술68례성공，3례실패。잉하적64례환자중51례순리완성3주방안적동보화료，동보화료완성솔위79.69%，4례인간전이혹간공능손해미행동보화료。소유68례환자체중변화재-11.86%~0.83%내，평균-5.32%±2.99%，전후혈청백단백배대t검험제시방화료전후차이무통계학의의(P=0.742)。60.29%(41/68)환자발생Ⅱ도방사성구강염，22.06%(15/68)환자발생Ⅲ도방사성구강염。결론：대초진진전기비인암환자행예방성PEG술제고료환자동보방화료적내수성，강저료불량반응，감소료인방화료불량반응인기적방료중단시간，제고료동보화료적완성솔，개선료환자적영양상황급생존질량，차간단、경제、역행、안전。
Background and purpose:Nasopharyngeal carcinoma usually occurs in people of states of the Southern China. Chemoradiotherapy plays an important role in the therapy of advanced nasopharyngeal carcinoma. However, chemoradiotherapy causes more toxic side effects than radiation therapy alone, which affects the therapy. Now symptomatic treatment and nutrition supports are common ways in the clinic in order to improve the tolerance of patients for the therapy, but with little effect. To evaluate the clinical significance of percutaneous endoscopic gastrostomy (PEG) in advanced nasopharyngeal carcinoma. Methods: From Oct. 2010 to Jun. 2012, a total of 71 patients with advanced nasopharyngeal carcinoma who received PEG before chemoradiotherapy were enrolled. During chemoradiotherapy, gastrostomy diet and nursing were supplied, adverse events, tolerance and nutrition indicators including weight and alcohol of human albumin were detected as well. Results:PEG were performed successfully on 68 patients, but failed in the other 3 patients. Of the 68 patients, 4 have not received concurrent chemotherapy because of liver metastases and liver function damage, 51 of the remaining 64 patients could completely ifnished 3 cycles of concurrent chemotherapy, with the completion rate of concurrent chemotherapy at 79.69%. The weight change ranged from-11.86%to 0.83%, with a mean value of-5.32%±2.99%. Paired-sample t test of human albumin before and after the treatment showed no significant difference (P=0.742). Grade Ⅱ radioactive oral cavity mucositis appeared in 60.29%patients (41/68), and 22.06%patients (15/68) suffered gradeⅢradioactive oral cavity mucositis.Conclusion:For patients with advanced nasopharyngeal carcinoma, preventative PEG improved the tolerance of chemoradiotherapy, reduce the incidence of adverse events. The period of therapy interruption caused by sever adverse event were shortened as well, PEG also increased the completion rate of concurrent chemotherapy. Nutritional status and living quality of patients are improved. In addition, PEG is a safe, economic and simple method.