氩离子凝固术加抑酸逆转Barrett’s食管上皮的临床研究  

Clinical Study on Reversal of Barrett's Esophagus with Argon Plasma Coagulation and Acid Suppression

作　　者：李启祥[1] 邓明[1] 尹合坤[1] 

机构地区：[1]广东江门市中心医院消化内科,江门529071

出　　处：《临床消化病杂志》2006年第5期279-281,共3页Chinese Journal of Clinical Gastroenterology

摘　　要：目的观察氩离子凝固术(APC)加抑酸治疗对Barrett’s食管上皮的逆转作用。方法对45例以内镜和病理确诊的Barrett’s食管病人,随机分为治疗组与对照组,治疗组采用氩离子凝固加质子泵抑制剂(APC)组,对照组采用传统质子泵抑制剂治疗(PPI组)。于治疗后第3个月和第6个月进行内镜及病理复查,观察2组Barrett’s食管上皮逆转情况。结果APC组23例Barrett’s食管上皮逆转总有效率在第3、6个月时分别为69.6%和82.6%,而对照组(PPI组)分别为9.5%和22.2%。无出血、穿孔等严重并发症。结论氩离子凝固术结合抑酸治疗能有效逆转Barrett’s食管上皮,大多数患者出现鳞状上皮再生,但不排除在新生的鳞状上皮下有残留的肠上皮化生及复发的可能,需长期随诊。Objective To assess whether restoration of squamous epithelium can be obtained after ablation of Barrett＇ s esophagus using argon plasma coagulation （APC） associated with proton pump inhibitor （PPI） therapy. Methods Single - blind, PPI controlled randomized study was made in patients with Barrett＇ s esophagus,23 patients were treated with APC and esomeprazole（40 mg/d） （APC group）. 22 patients were accomplished with esomeprazole （ 40 mg/d ） （ PPI group ）. The resuhes were observed by endoscopy and pathology after 3 and 6 months treatment. Results After 3 and 6 months＇ treatment, re - epithelialisation was visualized under endoscopy in 15/23 and 19/23 patients in APC group. At histological assessment, eradication of Barrett＇ s esophagus were confirmed in 11/23 and 15/23 patients, and in 5/23 and 4/23 patients the new squamous epithelium covered areas of underlying intestinal metaplasia . The total effective rates of reversal of Barrett＇ s esophagus were 69.6% and 82.6% respectively after 3 and 6 months treatment. In PPI group, endoscpy showed that 4/22 patients had complete squamous re-epithelialization after 6 months treatment. The total effective rate was 22.2% after 6 months treatment. There were no seriuos complications. Conclusion APC combined with 40 mg esomeprazole daily can eradicate Barrett＇ s mucosa with apparent squamous re - epithelialization in majority of patients. It is both efficacious and safe in the treatment of Barrett＇ s esophagus. However, the reappearance of squamous epithelium after therapy does not exclude the presence of underlying intestinal metaplasia.

关 键 词：Barrett’s食管 治疗 氩离子凝固术 肠上皮化生 

分 类 号：R571[医药卫生—消化系统]