摘要目的：评估食管癌患者 IMRT后食管瘘及出血发生情况及危险因素。方法收集2012—2014年在本院行根治性IMRT的128例食管癌患者临床资料，根据食管瘘或出血发生分为对照组105例与严重并发症组23例（食管瘘12例、食管出血11例），χ2分析比较组间差异，Cox模型多因素分析。结果初诊存在胸背部疼痛、临床分期为cT4期、肿瘤大体类型（为溃疡型）、GTV体积＞50 cm3、GTV最大横径＞2?45 cm均是食管癌放疗后食管瘘及出血发生的危险因素（ P＝0?042、0?042、0?019、0?046、0?002）。多因素分析显示大体分型（为溃疡型）（ P＝0?01，HR＝0?329，95％ CI为0．142～0?763）、GTV最大横径（＞2?45 cm）（ P＝0?009，HR＝3?805，95％ CI为1．404～10?312）是影响食管瘘及出血发生的危险因素。结论食管瘘及出血的发生严重制约IMRT疗效，对于溃疡型和GTV最大横径＞2?45 cm的食管癌患者应优化放化疗方案，降低严重并发症的发生风险。

abstractsObjective To evaluate the incidence of and risk factors for esophageal fistula and fatal bleeding after intensity?modulated radiotherapy ( IMRT) for esophageal cancer. Methods Clinical data were collected from 128 patients with esophageal cancer who received radical IMRT in our hospital from January 2012 to December 2014. According to the incidence of esophageal fistula and fatal bleeding, those patients were divided into control group ( n= 105 ) and severe complications group ( n= 23 ) . In the severe complications group,12 patients had esophageal fistula and 11 fatal bleeding. Between?group comparison was made by χ2 test. The Cox model was used for the multivariate analysis. Results Chest and back pain in the initial diagnosis,clinical stage cT4 ,tumor type ( ulcerative) ,gross tumor volume ( GTV)>50 cm3 ,and GTV maximum diameter>2?45 cm were risk factors for esophageal fistula and fatal bleeding after radiotherapy for esophageal cancer (P=0?042,0?042,0?019,0?046,0?002).The multivariate analysis showed that tumor type ( ulcerative) and GTV maximum diameter were independent risk factors for esophageal fistula and fatal bleeding ( P=0?010,HR=0?329,95% CI:0?142?0?763;P=0?009,HR=3?805,95% CI:1?404?10?312) . Conclusions The efficacy of IMRT is severely restricted by the incidence of esophageal fistula and fatal bleeding. For patients with an ulcerative type of esophageal cancer or a GTV max diameter of>2?45 cm,the chemoradiotherapy plan should be optimized to reduce the risk of severe complications.