小剂量长周期泼尼松对食管内镜黏膜下剥离术后食管狭窄的预防作用

The Preventive Effect of Low-Dose Long-Period Prednisone on Esophageal Stricture After Esophageal Endoscopic Submucosal Dissection

目的评估小剂量长周期泼尼松对大面积(≥3/4环周)内镜黏膜下剥离术(ESD)术后食管狭窄的疗效及安全性。方法回顾性分析2018年4月至2019年10月郑州大学第一附属医院收治的食管ESD术后创面≥3/4周径的92例患者的临床资料,分为对照组(A组)、常规剂量组(B组)、改良剂量组(C组)。A组ESD术后接受常规治疗。B组ESD术后第3天开始口服泼尼松,30 mg·d^-1,逐渐减量(第1~8周用量分别为30、30、25、25、20、15、10、5 mg·d^-1)后停药。C组ESD术后第3天开始口服泼尼松,30 mg·d^-1,每3周减5 mg(第1~18周用量分别为30、30、30、25、25、25、20、20、20、15、15、15、10、10、10、5、5、5 mg·d^-1)后停药。结果3组在年龄、性别、病变部位、长度、周径、深度、术后病理方面差异均无统计学意义(均P>0.05)。C组的狭窄发生率(19.4%)低于A组(84.6%)和B组(51.4%)(均P<0.01)。C组探条扩张次数[4(3~5)次]少于A组[9(7~10)次]和B组[6(4~7)次](均P<0.01)。C组首次出现狭窄的时间[(28.6±6.7)d]长于A组[(15.3±4.8)d]和B组[(23.9±7.0)d](均P<0.01)。B组(8.6%)和C组(16.1%)可能与激素相关的不良反应发生率差异无统计学意义(P>0.05)。结论改良剂量泼尼松能够降低ESD术后食管狭窄率,减少探条扩张次数,延长首次出现狭窄时间且安全性好。

Objective To evaluate the efficacy and safety of low-dose long-period prednisone for esophageal stenosis after large-area(≥3/4 circumference)endoscopic submucosal dissection(ESD).Methods The clinical data of 92 patients with esophageal ESD postoperative wounds≥3/4 circumference admitted to the First Affiliated Hospital of Zhengzhou University from April 2018 to October 2019 were retrospectively analyzed.Patients were divided into control group(Group A),conventional dose group(group B),modified dose group(group C).Group A received routine treatment after ESD.Group B began to take prednisone on the 3rd day after ESD,30 mg·d^-1,and gradually reduce the dosage(the prednisone dosage from the first week to the eighth week were 30,30,25,25,20,15,10,5 mg·d^-1 respectively).Group C began to take prednisone on the 3rd day after ESD,30 mg·d^-1,and reduce 5 mg every 3 weeks(the prednisone dosage from the first week to the eighteenth week were 30,30,30,25,25,25,20,20,20,15,15,15,10,10,10,5,5,5 mg·d^-1).Results There was no statistically difference among the three groups in age,sex,lesion site,length,circumference diameter,depth and postoperative pathology(all P>0.05).The incidence of stenosis in group C(19.4%)was lower than that in group A(84.6%)and group B(51.4%)(both P<0.01).The times of bougie dilation in group C[4(3-5)times]were less than that in group A[9(7-10)times]and group B[6(4-7)times](both P<0.01).The time of first occurrence of stenosis in group C[(28.6±6.7)d]were longer than that of group A[(15.3±4.8)d]and group B[(23.9±7.0)d](both P<0.01).The difference in the incidence of hormone-related adverse reactions between group B(8.6%)and group C(16.1%)was not statistically significant(P>0.05).Conclusion Low-dose long-period prednisone can effectively reduce the rate of esophageal stenosis after ESD,reduce the number of bougie dilation,prolong the time of first appearance of stenosis,and it is safe.