不同方法治疗Barrett食管的疗效观察

Effect of different treatments on Barrett's esophagus

目的比较不同方法治疗Barrett食管(BE)的疗效。方法将75例BE患者随机分为A、B、C、D组和对照组。A组口服奥美拉唑;B组口服铝碳酸镁;C组口服奥美拉唑+铝碳酸镁;D组行氩气凝固术(APC)+口服奥美拉唑及铝碳酸镁;对照组未行特殊治疗。比较五组患者治疗前后的临床、病理、内镜表现及食管上皮Ki-67水平。结果各治疗组临床症状均明显改善(P<0.05),组间比较无统计学差异(P>0.05);A、B、C组及对照组BE黏膜均未见明显缩小,D组91.3%的患者BE黏膜恢复正常;各治疗组Ki-67表达均低于对照组,D组低于A、B组(P均<0.05)。结论APC+奥美拉唑、铝碳酸镁方案可改善BE患者的临床症状、BE黏膜,降低Ki-67表达,安全性好,为BE的理想治疗方案。

[ Objective] To investigate the effect of different treatments on Barrett＇s esophagus （BE）. [ Methods] 75 patients with Barrett＇s esophagus diagnosed by endoscopy and biopsy were randomly divided into five groups： control group; group A （Omeprazole） ; group B （Hydrotalcite） ; group C （Omeprazole and Hydrotalcite） ; group D （Omeprazole and Hydrotalcite after argon plasma coagulation）. Specimens of esophageal tissues were collected and clinical effect was observed before and 3-month after treatments. Expression of Ki-67 in Barrett esophagus was investigated by immunohistochemistry and the differences were analyzed among groups. [ Results ] The symptoms in treatment groups were significantly improved than control groups after treating （ P 〈 0.05 ）. There were no significant differences in relieving clinical symptoms in group A, B,C and D （P 〉 0.05）. The mucosa areas of Barrett＇s esophagus didn＇ t change significantly in group A, B and C by endoscopy. Barrett＇s esophagus was eliminated in 91.3% patients in group D. There were significant differences in expression of Ki-67 in group A, B, C and D compared to control group （ P 〈 0.05 ）. Expression of Ki-67 was significantly different in group D compared with group A and B （ P 〈 0.05）. [ Conclusion ] Argon plasma coagulation combined with Omeprazole and Hydrotalcite can eradicate BE, relieve clinical symptom and affect the expression of Ki-67. It＇ s an effective and safe therapeutic regimen against Barrett＇s esophagus.