CAJ | 학술논문

目的：探讨中晚期食管癌支架置入术后再狭窄发生的危险因素。方法对2009年8月1日至2011年12月31日长治医学院附属和平医院65例中晚期食管癌患者行支架置入术后临床资料进行了回顾性分析。对中晚期食管癌支架置入术后再狭窄的相关因素进行单因素和多因素统计分析。结果单因素显示与临床分期（Ⅲ期和Ⅳ期，P＝0.024）、组织学分级（Ⅰ级、Ⅱ级和Ⅲ级，P＝0.001）、是否合并食管瘘（有食管瘘和没有食管瘘，P＝0.000）、支架置入术后治疗（是否接受放化疗， P＝0.004）相关。多因素Logistic回归分析显示，临床分期增加（Ⅲ期和Ⅳ期，P＝0.044）、组织学分级提高（Ⅰ级、Ⅱ级和Ⅲ级，P＝0.002）、合并食管瘘（有食管瘘和没有食管瘘，P＝0.001）是影响中晚期食管癌患者支架置入术后再狭窄的独立风险因素，其OR值（优势比）分别为5.448、14.533、66.221。而支架置入术后接受同步放化疗（ P ＝0.002）呈负相关， OR 值为0.020成为独立的保护因素。结论临床Ⅳ期、组织学分级提高、合并食管瘘成为支架置入术后再狭窄的的高危风险因素，对于支架置入术后接受同步放化疗是减少支架再狭窄的重要因素。对于具有高危再狭窄的患者，应采取更为积极的治疗措施以预防再狭窄发生。
목적：탐토중만기식관암지가치입술후재협착발생적위험인소。방법대2009년8월1일지2011년12월31일장치의학원부속화평의원65례중만기식관암환자행지가치입술후림상자료진행료회고성분석。대중만기식관암지가치입술후재협착적상관인소진행단인소화다인소통계분석。결과단인소현시여림상분기（Ⅲ기화Ⅳ기，P＝0.024）、조직학분급（Ⅰ급、Ⅱ급화Ⅲ급，P＝0.001）、시부합병식관루（유식관루화몰유식관루，P＝0.000）、지가치입술후치료（시부접수방화료， P＝0.004）상관。다인소Logistic회귀분석현시，림상분기증가（Ⅲ기화Ⅳ기，P＝0.044）、조직학분급제고（Ⅰ급、Ⅱ급화Ⅲ급，P＝0.002）、합병식관루（유식관루화몰유식관루，P＝0.001）시영향중만기식관암환자지가치입술후재협착적독립풍험인소，기OR치（우세비）분별위5.448、14.533、66.221。이지가치입술후접수동보방화료（ P ＝0.002）정부상관， OR 치위0.020성위독립적보호인소。결론림상Ⅳ기、조직학분급제고、합병식관루성위지가치입술후재협착적적고위풍험인소，대우지가치입술후접수동보방화료시감소지가재협착적중요인소。대우구유고위재협착적환자，응채취경위적겁적치료조시이예방재협착발생。
Objective To explore risk factors of restenosis after stent implantation in patients with advanced esophageal cancer .Methods We retrospectively analyzed the clinical records of 65 advanced esophageal cancer patients undergoing stent implantation between August 2009 and December 2012 .We also performed univariable and multivariabe analyses to identify the risk factors related to restenosis .Results The univariable analysis showed that restenosis was associated with clinical stage (ⅢvsⅣ,P=0.024 ) ,pathologic grade (Ⅰvs Ⅱvs Ⅲ, P =0.001 ), esophageal fistula ( yes vs no, P =0.000 ), and postoperative radiochemotherapy(yes vs no,P=0.004).Moreover,the multivariable logistic regression analysis revealed that increased clinical stage(OR=5.448,P=0.044),elevated pathologic grade(OR=14.533,P=0.002) and esophageal fistula ( OR=66.221 ,P=0.001 ) acted as independent risk factors responsible for restenosis after stent implantation .However , radiochemotherapy was found to be negatively related to restenosis after stent implantation and functioned as an independent protective factor ( OR =0.020 , P <0.05 ) . Conclusions Our investigation suggests clinicalⅣstage,elevated pathologic grade and esophageal fistula are risk factors initiating restenosis after stent implantation , while radiochemotherapy plays a pivotal role in the prevention against restenosis .For the individuals who are at high risk of restenosis , clinicians should take more efficient preventive measure .