激素不同给药途径预防浅表性食管癌内镜黏膜下剥离术后食管狭窄疗效观察

Therapeutic effect of different hormone administration routes on prevention of esophageal stricture after endoscopic submucosal dissection in superficial esophageal cancer

目的比较局部喷洒类固醇凝胶与局部注射曲安奈德预防浅表性食管癌内镜黏膜下剥离术后食管狭窄的有效性与安全性。方法纳入2015年10月至2017年7月郑州大学第一附属医院收治浅表性食管癌患者66例,均行ESD治疗,将患者随机分配为曲安奈德注射组(A组)、类固醇凝胶喷洒组(B组)及对照组(C组)三组,A组于ESD后立即在溃疡底部局部注射;B组患者ESD术后立即在黏膜缺损处喷洒类固醇凝胶;C组仅行ESD。术后1个月行胃镜检查,观察食管狭窄率及ESD术后溃疡愈合情况。术后随访6月,出现狭窄患者者行内镜下球囊扩张术(EBD)。结果 ESD后1个月进行内窥镜检查,A、B、C三组溃疡瘢痕期与非瘢痕期人数(S1/H2+H1+A2)分别为(15/6)、(16/6)、(19/4),S1期愈合率分别为71.4%、72.7%、82.6%,各组间无显着性差异(P>0.05);A、B、C三组狭窄与非狭窄人数分别为(4/17)、(2/20)、(17/5),狭窄率分别为19.0%、9.0%、73.9%,三组狭窄率比较差异有统计学意义(c2=25.987,P<0.01),两两比较,A组、B组分别与C组的狭窄发生率差异具有统计学意义(P<0.01);三组患者ESD术后随访6月,EBD治疗次数分别为2.0次(0～4.0次)、2.0次(0～3.0次)、6.0次(0～13.0次),差异有统计学意义(H=48.51,P<0.01);两两比较,A组与B组ESD术6月接受EBD次数差异有统计学意义(Z=1.99,P=0.033),A组与C组ESD术6月接受EBD次数差异具有统计学意义(Z=20.755,P=0.01),B组与C组ESD术6月接受EBD次数差异具有统计学意义(Z=35.167,P<0.01)。结论局部给予曲安奈德及局部类固醇凝胶给药均可降低食管狭窄率,降低术后EBD次数,但局部类固醇凝胶给药无论是在疗效、技术要求及术后不良反应方面均优于局部曲安奈德注射,两种给药途径均安全性好。

Objective To compare the efficacy and safety of topical sprayed steroid gels and local injection of triamcinolone acetonide for prevention of esophageal stricture after endoscopic submucosal dissection in superficial esophageal cancer.Methods Sixty-six patients with superficial esophageal cancer admitted to the First Affiliated Hospital of Zhengzhou University from October 2015 to July 2017 were treated with ESD.The patients were randomly assigned to the triamcinolone acetonide injection group(group A)and the hormone gel group.(group B)and control group(group C),group A was injected locally at the bottom of the ulcer immediately after ESD;Group B patients were immediately sprayed with steroid gel at the mucosal defect after ESD;Group C only performed ESD.Gastroscopic examination was performed 1 month after operation to observe the esophageal stenosis rate and ulcer healing after ESD.After 6 months of follow-up,endoscopic balloon dilatation(EBD)was performed in patients with stenosis.Results Endoscopy was performed 1 month after ESD.The number of ulcers and non-scars in the A,B,and C groups(S1/H2+H1+A2)were(15/6)and(16/6),respectively.19/4),the healing rate of S1 was 71.4%,72.7%,and 82.6%,respectively.There was no significant difference between the groups(P>0.05).The number of stenosis and non-stenosis in group A,B,and C were(4/17),(2/20),(17/5),the stenosis rate was 19.0%,9.0%,73.9%,respectively,the difference between the three groups of stenosis rate was statistically significant(c2=25.987,P<0.01),two In the two comparisons,the incidence of stenosis was significantly different between group A and group B(P<0.01).The three groups were followed up for 6 months after ESD,and the number of EBD treatments was 2.0(0~4.0).2.0 times(0~3.0 times),6.0 times(0~13.0 times),the difference was statistically significant(H=48.51,P<0.01);The difference between the two groups was the difference in the number of EBD received by ESD in group A and group B in June.Statistically significant(Z=1.99,P=0.033),the difference in the number of EBD received between group A and group C in ESD was statistically significant(Z=20.755,P=0.01),group B and group C ESD for June The difference in the number of times of receiving EBD was statistically significant(Z=35.167,P<0.01).Conclusion Local administration of triamcinolone acetonide and topical steroid gel can reduce the rate of esophageal stenosis and reduce the number of postoperative EBD,but topical steroid gel administration is superior to local curvature in terms of efficacy,technical requirements and postoperative adverse reactions.Anede injection,both routes of administration are safe.