内镜下氩离子凝固术联合奥美拉唑治疗Barrett食管76例临床及随访分析

Clinical analysis of argon plasma coagulation combined with omeprazole for treatment of Barrett's esophagus

目的探讨胃镜下氩离子凝固术联合奥美拉唑治疗Barrett食管的疗效。方法将胃镜检查并病理证实的76例Barrett食管(BE)患者随机分为对照组和治疗组,对照组36例给予口服奥美拉唑20 mg,1次/d;治疗组40例在胃镜下行氩离子凝固术(APC),术后给予口服奥美拉唑20 mg,1次/d,对于一次治疗不能清除病灶的患者,4周后进行第二次清除,于术后3、6、12个月进行胃镜复查,对其疗效及并发症进行评估。结果对照组在治疗过程中,胃镜下BE长度和范围未见明显改变;至随访结束前,治疗组镜下保持完全清除的BE食管患者占APC治疗的72.5%,治疗组临床缓解率明显高于对照组(P<0.05)。术后8例出现胸骨后不适,3例出现胸骨后疼痛,3例出现黏膜下气肿,2例出现低热。结论 Barrett食管的内镜下氩离子凝固术安全有效,有良好的临床应用前景。

Objective To investigate the effect of argon plasma coagulation combined with omeprazole for treatment of Barrett＇s esophagus.Methods Seventy-six patients with Barrett＇s esophagus diagnosed with endoscopy and biopsy were randomly divided into two groups.Control group was treated with 20 mg omeprazole once everyday,and treatment group was treated with argon plasma coagulation combined with omeprazole.If there was residual Barrett＇s esophagus,argon plasma coagulation was reperformed again after four weeks.All patients received the review of endoscopy and biopsy after 3,6 and 12 months.The effect and complications were evaluated.Results In the control group during the treatment,the length and scope of endoscopic BE had no significantly changed.At the end of the follow-up,the rate of patients whose esophagus remaind completely clear was 72.5% in treatment group.Clinical remission rate of treatment group was significantly higher that of control group（P0.05）.Some minor complications,such as retrosternal pain,sumbmucosal emphysema and low fever were found.Conclusion The treatment of argon plasma coagulation combined with omeprazole for Barrett＇s esophagus is effective and safe.