内镜下氩离子凝固术治疗Barrett食管疗效的探讨

Effect of argon plasma coagulation on the Barrett's esophagus

目的探讨内镜下氩离子凝固术(APC)联合抑酸剂埃索美拉唑镁治疗Barrett食管的临床疗效。方法对23例经病理证实的Barrett食管行内镜下氩离子凝固术(APC),治疗间隔为2周,直至病理证实复层鳞状上皮完全修复,术后给予抑酸剂埃索美拉唑镁20 mg/次,2次/d口服,共3个月,术后第6个月及1年进行内镜及组织学随访。结果 17例经1次APC根除,4例经2次APC根除,2例经3次APC根除,平均烧灼次数为1.3次。全部病例于治疗后6个月均获得治愈,4例于治疗后1年出现化生的柱状上皮黏膜岛,治疗总有效率为82.6%。7例出现剑突或胸骨后疼痛,经口服埃索美拉唑镁后症状缓解。结论 BE的内镜下APC联合抑酸剂埃索美拉唑治疗安全有效,但仍有一定比例的复发与残留。

【Objective】To study the clinical effect of argon plasma coagulation（APC） and acid suppression on reversal of Barrett＇s esophagus（BE）.【Methods】23 patients with histologically proven BE,underwent 60 W APC were analyzed.Each treatment interval is 2 weeks,until Pathologically confirmed that stratified squamous epithelium were repaired completely.Esomeprazole（20mg bid） was given to suppress acid.All patients underwent further surveillance endoscopy.【Results】The eradication was obtained in the 17 cases by only one session,4 cases re-quired two sessions,2 cases required three sessions.The mean number of APC sessions needs to complete ablation was 1.3.6 months later after APC,all cases were ablated completely.One year later after APC,4 patients had columnar epithelium island.The total effective rates of reversal of Barrett＇s esophagus were 82.6%.【Conclusion】 APC combined with acid suppression can ablate Barrett＇s mucosa safely and effectively.However,relapse and rem-nant still need to be paid attention.