氩气刀联合探条扩张在食管癌术后吻合口狭窄随机对照临床研究

Evaluation of Combined Argon Plasma Coagulation and Savary Bougienage for the Relief of Anastomotic-Stenosis after Esophageal Squamous Cancer Surgery

目的比较氩气刀联合探条与单独氩气刀或探条扩张治疗食管鳞癌术后吻合口狭窄的疗效。方法将食管鳞癌术后首次诊断吻合口狭窄的患者90例随机分为联合组(氩气刀联合探条)、氩气刀组和探条组,每组30例。完成治疗6个月后,比较各组无吞咽困难生存时间(第一次扩张有效缓解至吞咽困难复发时间)。结果治疗后6个月内无吞咽困难生存时间:联合组(115.63 d;95%CI:105.31~125.95)显著高于氩气刀组(39.53 d;95%CI:35.95~43.11,P<0.001)和探条组(16.93 d;95%CI:15.01~18.84,P<0.001)。3组均无严重并发症发生。结论内镜下氩气刀联合探条扩张治疗食管鳞癌术后吻合口狭窄是一种安全、耐受性良好的方法。

Objective To compare the effect of Argon Plasma Coagulation(APC)combined with Savary Bougienage(SB)to APC alone or SB alone for anastomotic-stenosis after radical operation for squamous cancer esophageal.Methods Patients with anastomotic-stenosis that was diagnosed for the first time following esophageal squamous cell carcinoma resection surgery were randomly assigned to undergo APC combined with SB,APC alone,or SB alone.A total of 90 patients from the Cancer Institute First Affiliated Hospital of Henan University of Science and Technology were entered randomly into the study(APC group,n=30,SB group,n=30,combination group:APC combined with SB,n=30).Primary endpoints were the dysphagia-free survival(DFS defined as the time from first dilatation of effectively relieved dysphagia to dysphagia relapse expressed in days)after 6 months of follow up.Results Primary endpoints:6 months after treatment,DFS of combination group(115.63 days;95%CI,105.31~125.95)was significantly longer than the APC alone group(39.53 days;95%CI,35.95~43.11,P<0.001)and the SB alone group(16.93 days;95%CI,15.01~18.84,P<0.001).No severe complications occurred within the three treatment groups.Conclusion APC combined with SB was a safe and well-tolerated method for relieving dysphagia of esophageal squamous cell cancer patients with anastomotic-stenosis.