内镜下放射状切开联合局部注射曲安奈德治疗食管良性狭窄的疗效观察

Endoscopic radial incision combined with local injection of triamcinolone acetonide for benign esophageal strictures

目的探讨内镜下放射状切开联合局部注射曲安奈德(ERITA)治疗食管良性狭窄的有效性及安全性。方法回顾性分析2018年1月-2021年10月就诊于该院的54例食管癌术后良性狭窄患者的临床资料,根据不同手术方法,将患者分为ERITA组(n=19)和内镜下探条扩张联合局部注射曲安奈德(EBDTA)组(n=35),比较两组治疗结果,并评估经治疗后狭窄复发和并发症发生情况。结果54例患者均顺利完成ERITA或EBDTA治疗。ERITA组中难治性食管狭窄患者占比更高,ERITA组的手术时间长于EBDTA组[(45.5±12.7)和(20.4±8.6)min],差异有统计学意义(P=0.032)。两组患者并发症总发生率比较,差异无统计学意义(P=0.527)。术后6个月随访,ERITA组术后狭窄复发中位时间明显长于EBDTA组(159.0和80.5 d,P=0.037),且ERITA组在治疗难治性食管狭窄患者方面疗效明显优于EBDTA组。结论ERITA治疗食管良性狭窄是安全有效的方法,在预防狭窄复发方面也具有较好的效果,未来可能成为一种治疗难治性食管良性狭窄患者的新的手段。

Objective To investigate the safety and the clinical effects of endoscopic radial incision combined with local injection of triamcinolone acetonide(ERITA)for benign esophageal strictures.Methods Medical records for 54 patients with benign esophageal stricture in postoperative esophageal cancer from January 2018 to October 2021 were retrospectively analyzed.According to different surgical methods,the patients were divided into ERITA group(n=19)and endoscopic bougienage dilation combined with local injection of triamcinolone(EBDTA)group(n=35).Comparing treatment outcomes between the two groups,and the recurrence and complications of stenosis after treatment were evaluated.Results All the 54 patients successfully completed ERITA or EBDTA.The proportion of patients with refractory esophageal stenosis was higher in ERITA group.The time of operation for the ERITA group was longer than that of the EBDTA group[(45.5±12.7)and(20.4±8.6)min,P=0.032].The total adverse event rate was no significant difference between the two groups(P=0.527).After six month of follow-up,the ERITA group was significantly longer than EBDTA group in maintaining the recurrence time of stenosis after operation(159.0 and 80.5 d,P=0.037),and the efficacy of ERITA in the treatment of refractory esophageal stenosis was significantly better than that of EBDTA group.Conclusion ERITA is effective and safe in patients with benign esophageal strictures,and it shows promising results for the prevention of stricture recurrence,we believe that it is a promising method for refractory benign esophageal strictures in the future。