激素预防食管早癌内镜黏膜下剥离术后食管狭窄效果的Meta分析  

Efficacy of steroid in prevention of esophageal strictures after endoscopic submucosal dissection for early esophageal cancer: A meta-analysis

作　　者：李贞娟[1] 柴宁莉[1] 令狐恩强[1] 冯佳[1] 翟亚奇[1] Li Zhenjuan;Chai Ningli;Linghu Enqiang;Feng Jia;Zhai Yaqi.(Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院消化科,北京100853

出　　处：《中华胃肠内镜电子杂志》2018年第1期18-28,共11页Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)

基　　金：国家重点研发计划(2016YFC1303601)

摘　　要：目的探讨激素预防食管早癌内镜黏膜下剥离术(ESD)术后食管狭窄的效果。方法检索截止2017年11月发表在CBM、Pubmed、Embase、Cochrane Library数据库中有关激素预防食管早癌ESD术后食管狭窄效果的相关研究,采用RevMan5.3软件对数据进行Meta分析。结果共有12项研究535例患者纳入分析。Meta分析结果显示,局部注射激素可降低食管早癌ESD术后食管狭窄发生率(RR=0.41,95%CI:0.27~0.63,P<0.0001),口服激素可降低非全环周ESD术后食管狭窄发生率(RR=0.25,95%CI:0.11~0.54,P=0.000 4),而对于降低全环周ESD术后食管狭窄发生率无明显效果(RR=0.54,95%CI:0.16~1.84,P=0.33)。口服激素(RR=-10.73,95%CI:-15.47^-5.98,P<0.0001)和局部注射激素(RR=-3.22,95%CI:-5.11^-1.34,P=0.0008)均可减少食管狭窄后EBD扩张次数。结论激素对于预防食管早癌ESD术后的食管狭窄是安全有效的;口服激素可以降低非全环周ESD术后食管狭窄的发生率,但对于预防全环周ESD术后食管狭窄无明显效果;口服激素和局部注射激素均可以减少ESD术后食管狭窄的EBD扩张次数,并且口服激素减少的效果优于局部注射激素。Objective To evaluate the efficacy of steroid in prevention of stricture after endoscopic submucosal resection （ESD） for early esophageal cancer. Methods Researches published in CBM, Pubmed, EMbase, the Cochrane Library database about the effect of steroid for prevention of stricture after ESD for early esophageal cancer were retrieved and screened. The expiration date for retrieval was in November 2017. RevMan5.3 software was used for the Meta-analysis. Results A total of 12 studies were included in the analysis, including 535 patients. The results of meta-analysis showed that local steroid injection could reduce the incidence of esophageal stricture （RR = 0. 41,95 % CI：0.27-0. 63, P 〈 0.000 1 ）. Oral steroid has no significant effect on reducing the incidence of esophageal stricture after circumferential ESD operation（RR = 0. 54,95% CI： 0. 16-1. 84, P = 0. 33 ）. It can reduce the incidence of esophageal stricture after semi-circumferential ESD surgery （RR = 0. 25,95% CI：0. 11-0.54, P = 0. 0004）. Both oral steroid （RR = - 10. 73.95% CI： - 15.47 ～- 5. 98,P 〈 0. 000 1 ） and local steroid injection （RR = -3.22,95% CI： -5.11 - -1.34,P = 0. 0008 ） can reduce required E BD sessions of esophageal stenosis. Conclusions Steroid for the prevention of stricture after ESD for early esophageal cancer is safe and effective;Oral steroid has no effect for the prevention of stricture after circumferential ESD, but can reduce stricture rate of senti-circunfferential ESD for esophageal lesions;Both oral steroid and local steroid injection can reduce required EBD sessions for stricture. And for the effect of reducing required EBD sessions for stricture, oral steroid is better than that of local steroid injection.

关 键 词：激素 内镜黏膜下剥离术 食管早癌 狭窄 预防 

分 类 号：R735.1[医药卫生—肿瘤]