浸润性溃疡性鳞状细胞癌化疗后成功切除食管穿孔

T. S. Rogova, P. G. Sakun, Y. Gevorkyan, S. Vlasov, L. Rozenko, S. Malinin, E. A. Karnaukhova, O. Rodionova, M. A. Komandirov, O. Y. Kaimakchi, N. Soldatkina, E. Gorbunova
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摘要

食管癌是最具侵袭性的胃肠道恶性肿瘤之一,在全球发病率结构中占第8位。尽管采取了综合治疗方法,但男女群体的死亡率都在继续增长,这使这种病理在恶性肿瘤死亡率结构中升至第六位。由于肿瘤定位或扩散过程的特殊性,许多患者在术前或单独接受放疗。在持续保守治疗的背景下,该疾病的严重并发症之一是食管穿孔,据文献报道,5.6% - 33%的病例会发生食管穿孔,发生这种并发症的危险因素是浸润-溃疡性癌症、疾病分期T3-4和存在食管狭窄,以及使用氟尿嘧啶、顺铂等化疗药物。本文报告一例食管鳞状细胞癌浸润-溃疡型患者在术前放化疗背景下发生食管穿孔的临床病例。并发症发生时的总病灶剂量(TFD)为24 Gy。由于全面的额外检查显示出现了食管穿孔的并发症,跨学科委员会决定立即进行手术干预,在此期间进行了胃和食管造口术切除食管。患者于第15天出院,情况令人满意,并建议进行免疫组化研究,以确定PD-L1表达的存在,以确定进一步的管理策略。本临床病例表明肿瘤的浸润-溃疡性生长形式、疾病的分期以及放射治疗期间化疗药物的使用是食管穿孔发生的危险因素;院前阶段选择此类患者的一项重要任务是在专业肿瘤中心进行彻底检查,以排除上述保守治疗过程中可能出现的并发症。
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Successful extirpation of a perforated esophagus after chemo radiotherapy in infiltrative ulcerative squamous cell carcinoma
Esophageal cancer is one of the most aggressive malignant neoplasms of the gastrointestinal tract, occupying the eighth place in the structure of morbidity worldwide. Despite comprehensive approaches to treatment, mortality continues to grow in both gender groups, which moves this pathology to the sixth position in the structure of mortality from malignant tumors. A lot of patients undergo radiation therapy in the preoperative period or in an independent version due to the peculiarities of the localization of the tumor or the spread of the process. One of the serious complications of the disease on the background of ongoing conservative therapy is perforation of the esophagus, which, according to the literature, can develop from 5.6 to 33 % of cases, and the risk factors for the development of this complication are infiltrative-u lcerative form of cancer, disease stage T3–4 and the presence of esophageal stenosis, as well as the use of chemotherapy drugs such as fluorouracil and cisplatin. The article describes a clinical case of esophageal perforation in a patient with infiltrative-u lcerative form of squamous cell carcinoma of the esophagus on the background of preoperative chemoradiotherapy. The total focal dose (TFD) at the time of complication development was 24 Gy. As a result of a comprehensive additional examination, which revealed a developed complication in the form of perforation of the esophagus, an interdisciplinary council decided on an immediate surgical intervention, during which extirpation of the esophagus with gastro- and esophagostomy was performed. The patient was discharged on the 15th day in a satisfactory condition with a recommendation to conduct an IHC study for the presence of PD-L1 expression to determine further management tactics. This clinical case demonstrates the role of the infiltrative- ulcerative form of tumor growth, the stage of the disease, as well as the use of chemotherapy drugs during radiation treatment as risk factors for the development of esophageal perforation; an important task at the prehospital stage in the selection of such patients is a thorough examination in specialized oncological centers to exclude possible complications in the process of the above conservative treatment.
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