人脱细胞羊膜移植预防内镜黏膜下剥离术后食管狭窄的临床评估

Transplantation of human acellular amniotic membrane for prevention of esophageal stricture in patients undergoing endoscopic esophageal submucosal dissection

目的评估人脱细胞羊膜(HAAM)移植预防大面积(≥3/4环周)早期食管癌内镜黏膜下剥离术(ESD)后食管狭窄的有效性及安全性。方法选取2011年6月—2021年12月宁波大学医学院附属医院收治的大面积(≥3/4环周)早期食管癌并行ESD治疗的患者53例。其中2011年6月—2016年6月收治的26例患者行常规ESD治疗(对照组),2016年7月—2018年12月收治的14例患者行ESD并术后口服强的松治疗(激素组),2019年1月至2021年12月收治的13例患者行ESD并创面移植HAAM治疗(试验组)。比较3组患者手术时间、并发症、术后食管狭窄发生率、顽固性狭窄发生率、吞咽困难缓解率等情况。结果3组患者ESD及相关治疗均成功,试验组患者手术时间与对照组和激素组比较差异无统计学意义(P>0.05)。3组患者均未发生迟发性出血、穿孔及纵隔感染等与内镜治疗相关的严重并发症,无死亡。试验组食管狭窄发生率(23.08%)低于对照组(65.38%),差异有统计学意义(P<0.05);试验组仅1例患者发生顽固性食管狭窄,其发生率与对照组比较差异无统计学意义(P>0.05);试验组和激素组食管狭窄和顽固性狭窄发生率比较差异无统计学意义(P>0.05)。术后随访3~58个月,平均30.2个月,3组患者吞咽困难均缓解,复查胃镜提示食管轻度狭窄或无明显食管狭窄。结论HAAM移植可有效预防大面积(≥3/4环周)早期食管癌ESD后的食管狭窄,安全可行。

Objective To evaluate the efficacy and feasibility of human acellular amniotic membrane(HAAM)transplantation for prevention of esophageal stricture in patients undergoing endoscopic esophageal submucosal dissection(ESD).Methods Fifty-three patients with early large area(≥3/4 of esophageal circumference)esophageal cancer who underwent ESD from June 2011 to December 2021 in the Affiliated Hospital of Medical School of Ningbo University were included in the study.The patients were divided into the control group(ESD alone)(n=26),the glucocorticoid group(ESD+oral prednisone)(n=14),and the HAAM group(ESD+HAAM transplant)(n=13).The incidence rate of total esophageal stricture and refractory stricture,the remission rate of dysphagia,operation duration and the complications were observed and compared among 3 groups.Results There were no significant differences among the 3 groups in gender,age and lesion size(P>0.05).All the 53 patients underwent ESD and the operations were successful.There was no significant difference in the operation time of HAAM,control group and glucocorticoid group(P>0.05).No severe compli-cations or death related to endoscopic treatment occurred.The incidence rate of total esophageal stricture in the HAAM group was lower than that in the control group(23.08%vs.65.38%,P<0.05),but there was no significant difference in incidence rate of refractory stricture between two groups(P>0.05).There were no significant differences in the incidence rate of total esophageal stricture and refractory stricture between HAAM group and glucocorticoid group(P>0.05).Dysphagia symptoms were alleviated in all patients at a mean time of 30.2 months(range 3-58 months).Conclusion HAAM transplant for prevention of esophageal stricture after large area endoscopic submucosal dissection is effective and safe for patients with large area esophageal cancer.