塞来昔布联合RFA/高频电凝电切治疗家族性腺瘤性息肉病的临床研究

A Clinical Study of Celecoxib Plus RFA/High Frequency Electrocoagulation and Electrocision in Treatment of Familial Adenomatous Polyposis

背景:非甾体抗炎药(NSAIDs)作用于环氧合酶(COX),研究发现长期服用NSAIDs能减少结肠癌的发病率和家族性腺瘤性息肉病(FAP)的癌变率。目的:观察选择性COX-2抑制剂塞来昔布联合射频消融(RFA)/高频电凝电切治疗对FAP患者结直肠息肉消退的作用及其安全性。方法:8例FAP患者行RFA/高频电凝电切治疗2年后,以RFA/高频电凝电切联合口服塞来昔布400mg/d继续治疗2年。记录息肉数量和大小,并检测其病理变化。结果:与治疗前相比,RFA/高频电凝电切治疗后平均息肉数无明显差异(480±210对450±235,P>0.05),但直径>1.0 cm的息肉数显著减少(22±10对10±8,P<0.05)。与RFA/高频电凝电切治疗相比,联合塞来昔布治疗后平均息肉数(450±235对50±42,P<0.01)和直径>1.0 cm的息肉数(10±8对4±1,P<0.05)均显著减少;组织病理学检查示管状腺瘤比例显著增加(P<0.01),腺瘤异型增生程度显著下降(P<0.01)。治疗期间无严重不良反应发生。结论:RFA/高频电凝电切治疗可明显减少直径>1.0 cm的息肉数,但平均息肉数无明显减少;联合塞来昔布治疗能明显减少平均息肉数和直径>1.0 cm的息肉数,降低腺瘤异型增生程度,且几乎无不良反应。

Background： Non-steroidal anti-inflammatory drugs （NSAIDs） act on cyclooxygenase （COX）, researches indicate that long-term NSAIDs treatment may reduce the incidence of colon cancer, and decrease the canceration rate of familial adenomatous polyposis （FAP）. Aims： To assess the effect and safety of celecoxib, a selective COX-2 inhibitor, plus radiofrequency ablation （RFA）/high frequency eleetrocoagulation and electroeision on the regression of colorectal polyps in FAP patients. Methods： Eight FAP patients were first treated with RFA/high frequency electrocoagulation and electrocision for 2 years, continued with RFA/high frequency electrocoagulation and electrocision plus celecoxib 400 mg/d for another two years. The number and size of the polyps were determined by endoscopy, and pathological changes of polyps were measured. Results： After the first two years＇ treatment of RFA/high frequency electrocoagulation and eleetrocision, there was no significant difference of the average number of polyps （480±210 vs. 450±235, P〉0.05）, but the number of polyps 〉1.0 cm reduced significantly （22±10 vs. 10±8, P〈0.05）. After treatment of RFA/high frequency electrocoagulation and electrocision plus celecoxib, both the average number of polyps （450±235 vs. 50±42, P〈0.01） and the number of polyps 〉1.0 cm （10±8 vs. 4±1, P〈0.05） reduced significantly. The pathological examination showed that the percentage of tubular adenoma increased （P〈0.01） and the grade of dysplasia reduced after RFA/high frequency electrocoagulation and electrocision plus celecoxib treatment （P〈0.01）. No severe adverse reaction was found during the treatment. Conclusions： Treatment of RFA/high frequency electrocoagulation and electrocision has no effect on the average number of polyps, but can reduce the number of polyps 〉1.0 cm in FAP patients. Treatment of RFA/high frequency electrocoagulation and electrocision plus celecoxib may lead to a significant reduction in the average number of polyps and the number of polyps 〉1.0 cm, and can also reduce the grade of dysplasia with almost no adverse reaction.