摘要
目的:探讨食管癌(esophageal cancer,EC)患者术后或放化疗后在上消化道内镜诊疗中突发危急情况时的多学科处置措施与价值。方法:回顾性入组2010年1月至2023年12月四川省肿瘤医院内镜中心上消化道内镜诊疗中突发危急情况并紧急行抢救的15例术后或放化疗后EC患者。患者危急情况均通过内镜危急值(endoscopic critical value,ECV)得到早期识别,并由多学科团队(multidisciplinary team,MDT)模式处置。多学科处置的措施与要点总结于本文中。结果:共15例EC患者在上消化道内镜诊疗中突发ECV事件,均为男性,年龄为(61.07±10.06)岁。ECV事件包括严重低氧血症9例,消化道大出血4例,误吸1例,心脏骤停1例。早期识别后,MDT对患者对症进行加压给氧、止血、清除异物、气管插管和心肺复苏等操作,本组病例均抢救成功。结论:EC术后或放化疗后患者全身基础情况差,内镜诊疗风险较大,易出现各种致命并发症。内镜诊疗中一旦发生ECV事件,急诊MDT处置模式可提高抢救成功率,保障患者生命安全。
Objective:To investigate the multidisciplinary management and its clinical values in addressing acute emergencies during upper gastrointestinal endoscopy in patients with esophageal cancer(EC)after surgery or chemoradiotherapy.Methods:Fifteen esophageal cancer patients after surgery or chemoradiotherapy who developed acute emergencies during upper endoscopy and required urgent intervention were retrospectively enrolled from the Endoscopy Center of Sichuan Cancer Hospital between January 2010 and December 2023.Acute endoscopic events were early identified via endoscopic critical values(ECV)and managed using a multidisciplinary team(MDT)approach.The multidisciplinary management protocols and key procedures were analyzed.Results:All 15 EC patients were male,aged(61.07±10.06)years,and developed ECV during endoscopy,including severe hypoxemia(9 cases),massive gastrointestinal hemorrhage(4 cases),aspiration(1 case),and cardiac arrest(1 case).After early recognition,targeted interventions such as high-flow oxygen therapy,hemostasis,foreign body extraction,endotracheal intubation,and cardiopulmonary resuscitation were executed through coordinated MDT actions.All patients in this cohort survived the acute events.Conclusion:Postoperative or post-chemoradiation esophageal cancer patients with compromised systemic status are at elevated risk for life-threatening endoscopic complications.Implementation of a structured MDT emergency protocol substantially enhances survival outcomes and safeguards patient safety during ECV.
作者
罗瑶
段寻梅
张莎
包郁
张真铭
李生平
赵锐
陈曦
刘新冰
张宏伟
毕刚
金海龙
任媛
Luo Yao;Duan Xunmei;Zhang Sha;Bao Yu;Zhang Zhenming;Li Shengping;Zhao Rui;Chen Xi;Liu Xinbing;Bi Gang;Jin Hailong;Ren Yuan;Zhang Hongwei(Department of Endoscopy,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China;Department of Surgical Anesthesia,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China;Oncology Emergency Department,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China)
出处
《肿瘤预防与治疗》
2025年第8期703-711,共9页
Journal of Cancer Control And Treatment
基金
四川省科技计划项目(编号:2022YFQ0045)
四川省科技厅重点研发项目(编号:2024YFFK0218)。
关键词
食管癌
上消化道内镜
内镜危急值
多学科处置
临床价值
Esophageal cancer
Upper gastrointestinal endoscope
Endoscopic critical value
Multidisciplinary management
Clinical value
