口服醋酸泼尼松预防内镜黏膜下剥离术后食管狭窄的疗效观察

Efficacy of oral prednisone acetate for prevention of esophageal stenosis after endoscopic submucosal dissection

目的观察口服醋酸泼尼松对食管癌前病变及早期癌内镜黏膜下剥离术(ESD)后食管狭窄预防的有效性以及安全性。方法回顾性分析2014年10月至2017年10月于南京鼓楼医院行ESD治疗的病变周径≥3/4周的56例食管癌前病变及早癌患者资料,根据患者术后是否服用醋酸泼尼松预防狭窄分为醋酸泼尼松组(n=26)和对照组(n=30)。2组患者如出现吞咽困难则予内镜下扩张治疗,比较2组临床资料、狭窄发生率、扩张次数以及并发症发生情况。结果2组患者在年龄、性别、病变部位、病变长度、病变形态、术后病理以及浸润深度分布方面差异均无统计学意义(P均>0.05)。醋酸泼尼松组食管全周型病变比例高于对照组[53.85%(14/26)比23.33%(7/30),χ^2=5.53,P=0.02]。醋酸泼尼松组与对照组相比,狭窄发生率下降[30.77%(8/26)比60.00%(18/30),χ^2=4.78,P=0.03],解决狭窄所需的扩张次数减少[(3.85±2.57)次比(9.83±5.82)次,t=7.22,P=0.00]。2组均无手术相关死亡事件发生,醋酸泼尼松组患者使用激素过程中未出现不良事件。结论口服醋酸泼尼松预防食管癌前病变及早期癌ESD术后食管狭窄安全有效。

Objective To investigate efficacy and safety of oral prednisone acetate for prevention of esophageal stenosis after endoscopic submucosal dissection (ESD) for patients with esophageal precancerous lesions or early esophageal carcinoma. Methods A retrospective analysis was performed on data of 56 patients who underwent circumferential or semi-circumferential (more than three quarters but not a complete circular) ESD for esophageal precancerous lesions or early cancer in Nanjing Drum Tower Hospital from October 2014 to October 2017. The patients were divided into the study group (n=26, prednisolone oral administration after ESD) and the control group (n=30, without prednisolone oral administration after ESD). Endoscopic dilatation was performed whenever patients experienced persistent dysphagia to solids. Clinical data, stricture rate, numbers of endoscopic dilatation, and adverse events were compared between the two groups. Results There were no differences in age, gender, location and length of lesions, endoscopic findings, depths of tumor invasion, and pathological subtypes between the two groups (all P>0.05). The proportion of circumferential esophageal lesions in the study group was higher than that in the control group[53.85% (14/26) VS 23.33% (7/30), χ^2=5.53, P=0.02]. The rata of post-procedural esophageal stricture in the study group was significantly lower than that in the control group[30.77% (8/26) VS 60.00% (18/30), χ^2=4.78, P=0.03], and the number of endoscopic dilatation was lesser in the study group than the control group (3.85±2.57 VS 9.83±5.82, t=7.22, P=0.00). There were no adverse events related to oral prednisone, and no treatment-related mortality. Conclusion Prednisone acetate oral administration is safe and effective to prevent esophageal stenosis after complete or semi-circular ESD for patients with esophageal precancerous lesions or early esophageal carcinoma.