氩离子凝固术联合药物治疗Barrett食管的临床研究

Clinical research on argon plasma coagulation combined with drugs in the treatment of Barrett's esophagus

目的探讨内镜下氩离子凝固术(argon plasma coagulation,APC)联合药物治疗Barrett食管(Barrett's esophagus,BE)的疗效。方法将90例BE患者按随机数字表法分为对照组和试验组各45例,试验组先给予单纯药物治疗8周(雷贝拉唑20 mg,bid,莫沙比利5 mg tid,铝碳酸镁片1 g tid),停药4周后复查胃镜,BE病灶仍存在者再行APC,术后服上述同样药物治疗;对照组先胃镜下行APC,术后再给予同样药物治疗。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,直至病灶消失。两组APC均在无痛胃镜、窄带成像(NBI)及透明帽辅助下完成。于术后6、12、24个月进行NBI辅助下胃镜复查,对其疗效及并发症进行评估。结果试验组在单纯药物治疗3个月后胃镜下BE病灶未见明显改变;随访24个月,试验组镜下保持完全清除的BE食管患者占APC治疗的97.8%,明显高于对照组的77.8%(P<0.05)。两组临床症状缓解率(93.3%,86.6%)比较,差异无统计学意义,术后均无严重不良反应。结论单纯药物治疗虽不能消除BE黏膜病理改变,但可以缓解症状,减少APC后复发;先药物治疗2个月,再联合无痛胃镜下NBI及透明帽辅助下APC治疗BE疗效显著,有良好的临床应用前景。

Objective To investigate the effectiveness of argon plasma coagulation combined with drugs in the treatment of Barrett＇s esophagus （BE）.Methods Ninety patients with BE were randomly divided into control or treatment group ,45 in each group. The treatment group was firstly given drugs for 8 weeks （Rabe-prazole 20 mg bid,Mosapride 5 mg tid,Hydrotalcite Tablets 1 g tid）,and then,review of gastroscopy was applied after 4 weeks of withdrawal .If patients with BE lesions still existed ,the argon plasma coagulation （ APC） ablation was performed and the same drugs were used after operation .The control group was treated with APC and the same drugs treatment after operation .For patients whose lesions were not removed in one operation ,APC was repeated every 4？ weeks until all lesions removed .All APC ablations were completed under painless gastroscopy with assist of narrow band imaging （ NBI） and trans-parent cap.Two groups received the review of endoscopy and biopsy after 6,12 and 24 months in NBI.The effects and complications were evaluated .Results In the treatment group after 3 months drugs treatment ,BE lesions showed no significantly changes .At the 24 th month of the follow-up,the rate of patients whose esophagus remained completely ablation was 97.8%in treatment group and 77.8%in the control group .Clinical remission rate in the treatment group was significantly higher than that in the control group （ P〈0.05 ） . There were no difference in clinical symptoms remission rates ,and no serious postoperative complications between the two groups .Con-clusion The pure drugs treatment cannot eliminate BE mucosa pathological changes ,but can relieve symptoms ,reduce recurrence after the APC.Drug treatment for 2 months,and then APC aided by NBI and transparent cap under painless gastroscopy ablate BE effective -ly.It has a good prospect of clinical application .