糖皮质激素联合临时支架置入预防环周或近环周内镜黏膜下剥离术后食管狭窄中的应用价值

Application value of glucocorticoid combined with temporary stent placement in preventing esophageal stenosis after circumferential or near circumferential endoscopic submucosal dissection

目的探讨糖皮质激素联合临时支架置入预防环周或近环周内镜黏膜下剥离术(ESD)后食管狭窄的疗效。方法前瞻性纳入2019年1月—2021年6月在陕西省铜川市耀州区人民医院接受环周或近环周ESD患者为研究对象。ESD后应用全覆膜支架附着在手术创面上,术后6~8周取出支架。所有患者术后第3天起口服泼尼松,逐渐减量至第8周结束。根据临时性支架置入情况将患者分为支架置入组和无支架置入组。收集所有患者的年龄、性别、术前病理结果、病变位置、ESD后的黏膜纵向缺损长度、病变占食管环周范围;记录食管狭窄患者的内镜下球囊扩张术(EBD)次数;记录可能与激素给药相关的不良反应。分析临时性支架置入预防ESD后食管狭窄的有效性;分析影响狭窄预防措施效果的因素。结果本研究最终共纳入36例患者,其中支架置入组26例,无支架置入组10例。支架置入组患者平均随访(13.7±4.5)个月,食管狭窄发生率为38.5%(10/26),平均EBD次数为(5.5±3.3)次;无支架置入组食管狭窄发生率为90.0%(9/10),平均EBD次数为(10.5±4.3)次。无支架置入组狭窄发生率及ESD次数高于支架置入组,差异有统计学意义(P<0.01)。病理结果为鳞状细胞癌、ESD后的黏膜纵向缺损长度越长、病灶范围为全周食管的患者术后食管狭窄发生率较高,差异有统计学意义(P<0.05)。结论临时支架置入结合糖皮质激素在减少环周或近环周ESD后狭窄发生和提高生活质量方面是有效和可行的。

Objective To investigate the efficacy of glucocorticoid combined with temporary stent placement in preventing esophageal stenosis after circumferential or near circumferential endoscopic submucosal dissection(ESD).Methods Patients received circumferential or near circumferential ESD in People’s Hospital of Yaozhou District in Tongchuan City of Shaanxi Province from January 2019 to June 2021were prospectively included in the study.After ESD,the fully covered stent was attached to the surgical wound,and the stent was removed 6 to 8 weeks after operation.All the patients took prednisone orally from the 3rd day after operation,and then the dosage gradually reduced to the end of the 8th week.According to the situation of temporary stent placement,the patients were divided into stent placement group and non-stent placement group.The age,gender,preoperative pathological results,lesion location,length of longitudinal mucosal defect after ESD and the range of lesion around the esophagus were collected in all the patients;the number of endoscopic balloon dilation(EBD)in patients with esophageal stenosis was recorded;adverse reactions that may be related to hormone administration were recorded.Efficiency of temporary stent placement in preventing esophageal stenosis after ESD was analyzed;the factors affecting the efficacy of stenosis prevention measures were analyzed as well.Results Finally,a total of 36 patients were included in this study,including 26 patients in the stent placement group and 10 patients in the non-stent placement group.In the stent placement group,the average follow-up was(13.7±4.5)months,the incidence of esophageal stenosis was 38.5%(10/26),and the average number of EBD was(5.5±3.3)times;in the non-stent placement group,the incidence of esophageal stenosis was 90.0%(9/10),and the average number of EBD was(10.5±4.3)times.The incidence of stenosis and the number of ESD in the non-stent placement group were significantly higher than those in the stent placement group(P<0.01).Patients with pathological result confirmed as squamous cell carcinoma,the longer longitudinal defect of mucosa after ESD was,and the higher incidence rate of postoperative esophageal stenosis was in patients with focus range involved the whole esophagus,and the differences were statistically significant(P<0.05).Conclusion Temporary stent placement combined with glucocorticoids is effective and feasible in reducing incidence of stenosis and improving quality of life after circumferential or near circumferential ESD.