口服糖皮质激素预防大面积ESTD术后食管狭窄的疗效评价

Efficacy of Oral Corticosteroids in Preventing Esophageal Stenosis after Large Area Endoscopic Submucosal Tunnel Dissection

目的探索口服糖皮质激素对大面积早期食管癌内镜黏膜下隧道剥离术(ESTD)术后食管狭窄的预防效果。方法纳入2014年1月1日至2018年1月1日在我院消化内镜中心因早期食管癌行ESTD治疗的患者(单一病灶占据食管管腔≥3/4周),并根据入组时间分为试验组(ESTD+口服强的松)及对照组(单纯ESTD),分析两组食管狭窄发生率、顽固性食管狭窄发生率、吞咽困难症状缓解率及食管狭窄发生时间。结果共101例患者纳入研究,其中试验组48例,男28例,女20例,平均年龄(62.98±7.52)岁;对照组53例,男28例,女25例,平均年龄(62.67±8.04)岁。试验组顽固性食管狭窄率低于对照组(6.25%vs.20.75%,P<0.05);试验组非顽固性狭窄患者的平均内镜治疗次数少于对照组[(1.85±0.27)次vs.(3.24±0.49)次,P<0.05];且试验组发生食管狭窄的平均时间为术后51.06d,晚于对照组(29.12d,P<0.05)。结论口服糖皮质激素可有效减轻大面积ESTD术后食管狭窄的程度,明显减低术后顽固性食管狭窄的发生率,减少非顽固性食管狭窄患者内镜治疗的次数,可作为预防ESTD术后狭窄的措施之一。

Objective To evaluate the efficacy of oral corticosteroids in preventing esophageal stenosis after large area esophageal endoscopic submucosal tunnel dissection （ESTD）. Methods The patients undertook esophageal ESTD were included from January 2014 to January 2018. The inclusion criteria was single lesion of esophageal early esophagus cancer with the extent more than 3/4 of circumferential degree. According to the inclusion time, the patients were divided into the trial group （ESTD ＋ oral corticosteroids） and the control group （simple ESTD）. The incidence of the total esophageal stenosis, intractable esophageal stenosis, the remission rate of dysphagia and the period from the dysphagia present were observed and compared in the two groups. Results A total of 101 cases of esophageal ESTD patients were included. There were 48 cases in the trial group, 28 cases of male and 20 cases of female, with an average age of （62.98±7.52） years; 53 cases in the control group, 28 cases of male and 25 cases of female, with an average age of （62.67±8.04） years. The rate of intractable esophageal stenosis in the trial group was lower than that in the control group （6.25% vs. 20.75%, P〈0.05）. The average endoscopic treatment times in the non-refractory stenosis patients in the trial group were significantly less than those in the control group 〔（1.85±0.27） times vs. （3.24±0.49） times, P〈0.05〕, and the occurrence time of esophageal stenosis in the trial group was 51.06 d after ESTD, significantly later than that in the control group （29.12 d, P〈0.05）. Conclusion Oral corticosteroids can effectively reduce the degree of esophageal stenosis after large area ESTD, as well as the incidence of intractable esophageal stenosis and the number of endoscopic treatment in non-refractory esophageal stenosis patients.