不同疗程糖皮质激素对食管黏膜下剥离术后食管狭窄预防的效果

doi:10.3969/j.issn.1004-583X.2024.10.005

摘要/Abstract

摘要：

目的对比分析糖皮质激素不同疗程及减药方式对内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)术后预防食管狭窄的效果。方法回顾性收集2017年1月至2023年1月在我科因食管早癌和癌前病变行ESD手术,术后采取口服激素的方式预防食管狭窄的患者共67例,依据术后口服糖皮质激素的方式分别纳入3周组、8周组、12周组。对比不同组别的食管狭窄情况、狭窄后行球囊扩张的次数、激素相关并发症等情况。结果 3周组、8周组、12周组的ESD术后食管狭窄率分别为23.8%(5/21)、22.9%(8/35)、18.2%(2/11),差异无统计学意义(P>0.05)。狭窄后应用内镜下球囊扩张的平均次数分别为3周组(2.80±0.84)次、8周组(2.25±0.71)次、12周组(2.50±0.71)次,差异无统计学意义(P>0.05)。激素相关不良反应的发生率分别为0, 5.7%(2/35), 27.3%(3/11),其中,3周组与8周组的激素相关不良反应发生率差异无统计学意义(P>0.05),而3周组与12周组(P=0.012)、8周组与12周组激素相关不良反应发生率(P=0.045)差异有统计学意义。结论口服糖皮质激素可预防食管大面积ESD术后狭窄。3周疗法、8周疗法、12周疗法在预防狭窄及狭窄后球囊扩张次数上具有相似效果,但短期、小剂量激素应用其不良反应最少,安全性高。

关键词: 食管狭窄, 糖皮质激素, 内镜黏膜下剥离术, 食管肿瘤, 内镜下治疗

Abstract:

Objective To compare and analyze the effects of different courses and reduction methods of glucocorticoids on preventing esophageal stenosis after endoscopic submucosal dissection (ESD). Methods A total of 67 patients who underwent ESD surgery for early esophageal cancer and precancerous lesions and orally medicated with glucocorticoids postoperatively to prevent esophageal stricture in our department from January 2017 to January 2023 were retrospectively included. According to the postoperative oral corticosteroids, patients were divided into the 3-week group, 8-week group, and 12-week group. Esophageal stricture, number of balloon dilations after stricture, and hormone-related complications were compared among the three groups. Results The esophageal stricture rate after ESD in the 3-week group, 8-week group, and 12-week group was 23.8%(5/21), 22.9%(8/35), and 18.2%(2/11), respectively, without a significant difference (P>0.05). The average number of endoscopic balloon dilations after stenosis in the 3-week group, 8-week group, and 12-week group was (2.80±0.84) times, (2.25±0.71) times and (2.50±0.71) times, respectively, without a significant difference (P>0.05). The incidence of hormone-related adverse reactions was 0, 5.7%(2/35), and 27.3%(3/11), respectively, without a significant difference (P>0.05). There was a significant difference in the incidence of hormone-related adverse reactions between the 3-week group and the 12-week group (P=0.012), and that between the 8-week group and the 12-week group (P=0.045).Conclusion Oral glucocorticoids can prevent esophageal stenosis after extensive ESD. Three-week therapy, eight-week therapy and twelve-week therapy have similar effects in the prevention of stenosis and the number of balloon dilatation after stenosis. However, short-term and low-dose hormone use has the least adverse reactions and high safety.

Key words: esophageal stenosis, glucocorticoid, endoscopic submucosal dissection, esophageal neoplasms, endoscopic treatment

中图分类号:

R571.1

李喆楠, 朱雪娟, 李上, 王军民. 不同疗程糖皮质激素对食管黏膜下剥离术后食管狭窄预防的效果[J]. 临床荟萃, 2024, 39(10): 896-900.

Li Zhenan, Zhu Xuejuan, Li Shang, Wang Junmin. Effect of glucocorticoids with varied courses on the prevention of esophageal stricture after esophageal submucosal dissection[J]. Clinical Focus, 2024, 39(10): 896-900.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.10.005

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I10/896

图/表 3

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组别	例数	年龄 (岁)	性别[例(%)]		创面大小[例(%)]		浸润深度[例(%)]		病理[例(%)]
组别	例数	年龄 (岁)	男	女	3/4周	环周	黏膜层	黏膜下层	低级别上皮内瘤变	高级别上皮内瘤变	鳞癌
3周组	21	63.76±7.67	12(57.1)	9(42.9)	17(81.0)	4(19.0)	12(57.1)	9(42.9)	5(23.8)	12(57.1)	4(19.0)
8周组	35	65.80±7.69	20(57.1)	15(42.9)	24(68.6)	11(31.4)	19(54.3)	16(45.7)	8(22.9)	19(54.3)	8(22.9)
12周组	11	66.18±7.71	5(45.5)	6(54.5)	7(63.6)	4(36.4)	7(63.6)	4(36.4)	1(9.1)	5(45.5)	5(45.5)
t/χ²值		0.564	0.508		1.405		0.300		3.238
P值		0.572	0.776		0.495		0.861		0.519

组别	例数	年龄 (岁)	性别[例(%)]		创面大小[例(%)]		浸润深度[例(%)]		病理[例(%)]
组别	例数	年龄 (岁)	男	女	3/4周	环周	黏膜层	黏膜下层	低级别上皮内瘤变	高级别上皮内瘤变	鳞癌
3周组	21	63.76±7.67	12(57.1)	9(42.9)	17(81.0)	4(19.0)	12(57.1)	9(42.9)	5(23.8)	12(57.1)	4(19.0)
8周组	35	65.80±7.69	20(57.1)	15(42.9)	24(68.6)	11(31.4)	19(54.3)	16(45.7)	8(22.9)	19(54.3)	8(22.9)
12周组	11	66.18±7.71	5(45.5)	6(54.5)	7(63.6)	4(36.4)	7(63.6)	4(36.4)	1(9.1)	5(45.5)	5(45.5)
t/χ²值		0.564	0.508		1.405		0.300		3.238
P值		0.572	0.776		0.495		0.861		0.519

组别	例数	狭窄	未狭窄
3周组	21	5(23.8)	16(76.2)
8周组	35	8(22.9)	27(77.1)
12周组	11	2(18.2)	9(81.8)
χ²值		0.141
P值		0.932

组别	例数	狭窄	未狭窄
3周组	21	5(23.8)	16(76.2)
8周组	35	8(22.9)	27(77.1)
12周组	11	2(18.2)	9(81.8)
χ²值		0.141
P值		0.932