特殊肠化生型巴雷特食管的内镜治疗效果评价

Endoscopic therapeutic effect on Barrett esophagus with special intestinal metaplasia

目的评价特殊肠化生型巴雷特食管(Barrett esophagus, BE)的内镜治疗效果。方法 2017年1月-2019年12月在武汉大学人民医院确诊特殊肠化生型BE, 并分别行内镜下射频消融术(endoscopic radiofrequency ablation, ERFA)、内镜黏膜切除术(endoscopic mucosal resection, EMR)治疗的56例患者纳入回顾性分析, 主要观察术后出血、进食梗阻、手术时间、住院时间和残留或复发等。结果 ERFA组(n=43)与EMR组(n=13)在患者年龄、性别、BE长度、术前消化道症状及合并症方面差异均无统计学意义(P>0.05)。相对于ERFA组, EMR组术后出血发生率[23.1%(3/13)比0, P=0.010]、进食梗阻发生率[30.8%(4/13)比4.7%(2/43), P=0.022]较高, 手术时间[6.0(5.6, 6.2)min比5.4(5.2, 5.5)min, Z=4.95, P<0.001]及住院时间[6.0(5, 7)d比3.5(3, 4)d, Z=5.76, P<0.001]较长。术后疼痛及发热发生率2组比较差异无统计学意义(P>0.05)。EMR组患者随访期间均未见肠化生病灶残留或复发, ERFA组第1次治疗后随访活检发现41.9%(18/43)的患者存在肠化生残余病灶, 差异有统计学意义(P=0.005)。结论 EMR治疗特殊肠化型BE更彻底;而ERFA治疗操作更简单, 用时较短, 术后并发症较少, 在临床应用更为广泛。

Objective To evaluate the endoscopic therapeutic effect on Barrett esophagus(BE)with special intestinal metaplasia.Methods A retrospective analysis was performed on data of 56 patients of BE with special intestinal metaplasia who were diagnosed in Renmin Hospital of Wuhan University from January 2017 to December 2019 and treated with endoscopic radiofrequency ablation(ERFA)or endoscopic mucosal resection(EMR).The postoperative bleeding rate,feeding obstruction rate,operative time,hospital stay and residual or recurrent intestinal metaplasia lesions were studied.Results There were no significant differences between the ERFA group(n=43)and the EMR group(n=13)in terms of age,gender,length of BE,preoperative gastrointestinal symptoms and comorbidity(P>0.05).The postoperative bleeding rate[23.1%(3/13)VS 0,P=0.010]and feeding obstruction rate[30.8%(4/13)VS 4.7%(2/43),P=0.022]were higher in the EMR group compared with those in the ERFA group,and the operative time[6.0(5.6,6.2)min VS 5.4(5.2,5.5)min,Z=4.95,P<0.001]and hospital stay[6.0(5,7)d VS 3.5(3,4)d,Z=5.76,P<0.001]were longer in the EMR group.There were no significant differences in the incidences of postoperative pain or fever between the two groups(P>0.05).No residual or recurrent intestinal metaplasia lesions were observed during the follow-up in any EMR patient,and follow-up biopsies after the first treatment in the ERFA group revealed residual intestinal metaplasia lesions in 41.9%(18/43)patients,with a significant difference(P=0.005).Conclusion EMR is more thorough in the treatment of BE with special intestinal metaplasia,while ERFA is more widely used in clinical practice for simpler operation,shorter operative time,and less postoperative complications.