内镜下扩张联合注射丝裂霉素治疗食管良性狭窄的疗效评价

Endoscopic dilation combined with intramuscular injection of mitomycin C for benign esophageal strictures

目的评价内镜下扩张联合注射丝裂霉素治疗食管良性狭窄的安全性和有效性。方法对89例接受内镜下扩张联合或不联合药物注射治疗的食管良性狭窄患者进行回顾性研究，扩张联合注射丝裂霉素者（丝裂霉素组）30例、扩张联合注射地塞米松者（激素组）29例、单纯扩张者30例，对比分析各组间治疗完成情况、并发症发生情况及治疗效果。结果89例均顺利完成了内镜下治疗，治疗后都达到了内镜和临床缓解。各组术后均未出现大出血，丝裂霉素组发生术后严重并发症1例（穿孔）和术后轻微并发症7例，激素组发生术后轻微并发症9例，单纯扩张组发生术后轻微并发症7例，3组间术后严重并发症发生率及轻微并发症发生率差异均无统计学意义（P〉0．05）。术后食管通畅时间丝裂霉素组为（5．25±1．18）个月，激素组为（4．46±1．53）个月，单纯扩张组为（3．03±1．62）个月，3组间差异有统计学意义（P〈0．05）。结论内镜下扩张联合注射丝裂霉素、地塞米松及单纯扩张治疗食管良性狭窄均安全有效，但联合注射药物治疗效果优于单纯扩张，且以联合注射丝裂霉素治疗效果更优。

Objective To evaluate the safety and efficacy of an endoscopic dilation in association with the intramuscular injection of either mitomycin C for benign esophageal strictures. Methods A total of 89 patients with benign esophageal strictures were retrospectively divided into 3 groups, including 30 cases of dilation combined with mitomycin C injection （mitomycin C group ）, 29 of dilation combined with dexamethasone injection （dexamethasone group） and 30 of dilation with saline injection （dilation group）. The successful rate, complications and the clinical effect in the 3 groups were compared. Results The 89 patients all successfully received the procedure, with the endoscopic and clinical release. No massive hemorrhage occurred. In mitomycin C group, 1 case with major complication （perforation） and 7 minor complication occurred; 9 and 7 cases with minor complication occurred in dexamethasone group and dilation group, respectively. There were no significant difference of the complications in the 3 groups （ P 〈 0. 05）. The mean dysphagia-free period was 5.25 ±1.18 months in the mitomycin C group, 4. 46 ± 1.53 months in the dexarnethasone group, and 3.03 ±1.62 months in the dilation group （ P 〈 0. 05 ）. Conclusion Endoscopic dilation with or without the intramuscular injection of either mitomycin C or dexamethasone are safe and effective. Dilation combined with drug injection may prolong the esophageal dysphagia-free period. Furthermore, mitomycin C injection may have the dominant effect.