PROSPECTIVE RANDOMIZED TRIAL OF LASER THERAPY ONLY AND LASER THERAPY FOLLOWED BY ENDOSCOPIC INTUBATION FOR THE PALLIATION OF MALIGNANT DYSPHAGIA
PROSPECTIVE RANDOMIZED TRIAL OF LASER THERAPY ONLY AND LASER THERAPY FOLLOWED BY ENDOSCOPIC INTUBATION FOR THE PALLIATION OF MALIGNANT DYSPHAGIA
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DOI：
10.1136/gut.31.3.252
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发表时间：
1990-03-01
期刊：
影响因子：
24.5
通讯作者：
WALKER, RJ
中科院分区：
文献类型：
--
作者：
BARR, H;KRASNER, N;WALKER, RJ
46例因恶性吞咽困难而入院的患者前瞻性随机接受仅激光治疗或初始激光治疗后内镜插管。每组治疗20例患者，排除6例。患者的吞咽能力在他们的生活之前和在他们的剩余时间中在0-4量表上进行评估，其中0为正常吞咽，4为完全吞咽困难。同时使用医生的评估（QL指数）和患者自己的评估（使用线性模拟自我评估（LASA））来测量患者的生活质量。所有QL指数和收集的LASA评分之间存在显著相关性（n = 126; rs = 0.594，p < 0.001）。平均每月吞咽困难等级与QL指数（r2 = 0.433，p < 0.001）和LASA（rs = 0.272，p < 0.002）相关。两组患者治疗前后吞咽困难程度无显著性差异。然而，仅用激光治疗的患者吞咽困难的波动比插入管的患者更大。两组患者的生活质量也没有显著差异。插管患者的并发症发生率（激光仅10%，激光/插管40%，p < 0.05）显著较高。插管治疗患者的复发性吞咽困难率（仅激光25%，激光/插管45%，NS）较高，但需要较少的内镜手术。总体而言，两种手术均能有效缓解吞咽困难并维持生活质量。两组均无手术相关死亡。
Forty six consecutive patients admitted for the relief of malignant dysphagia were prospectively randomised to receive laser therapy only or initial laser therapy followed by endoscopic intubation. Twenty patients were treated in each group with six exclusions. The patients'' swallowing ability was assessed before and during the remainder of their life on a 0-4 scale with 0 being normal swallowing and 4 total dysphagia. The patient''s quality of life was measured at the same times, using a physician''s assessment (QL index) and the patient''s own assessment using a linear analogue self assessment (LASA). There was a significant correlation between all the QL index and the LASA scores collected (n = 126; rs = 0.594, p < 0.001). The mean monthly dysphagia grade correlated with the QL index (r2 = 0.433, p < 0.001) and the LASA (rs = 0.272, p < 0.002). There was no significant difference in the dysphagia grade before or after treatment in either group. Dysphagia fluctuated more in those treated with the laser only, however, than in those with a tube inserted. There was also no significantly difference in the quality of life measured between the two groups of patients. The complication rate (laser only 10%, laser/intubation 40%, p < 0.05) was significantly higher in intubated patients. The recurrent dysphagia rate (laser only 25%, laser/intubation 45%, NS) was higher in patients treated with intubation, but they required fewer endoscopic procedures. Overall both procedures were effective in relieving dysphagia and in maintaining quality of life. There was no procedure related mortality in either group.