内镜下喷洒苦参素预防食管黏膜下剥离术后瘢痕狭窄的临床研究  

Clinical study on the prevention of cicatricial stenosis after esophageal submucosal dissection by spraying oxymatrine under endoscope

作　　者：唐静[1] 沈文拥 杨丹[1] 吴涛[1] 况晶 何小庆 刘爱民[1] TANG Jing;SHEN Wenyong;YANG Dan;WU Tao;KUANG Jing;HE Xiaoqing;LIU Aimin(Department of Gastroenterology,Chongqing University Fuling Hospital,Chongqing 408099,China)

机构地区：[1]重庆大学附属涪陵医院消化内科,重庆408099

出　　处：《重庆医学》2023年第9期1325-1329,共5页Chongqing medicine

基　　金：重庆市科卫联合医学科研项目(2019ZY023479)。

摘　　要：目的探讨早期食管癌患者内镜黏膜下剥离术(ESD)后创面局部喷洒硫糖铝凝胶和苦参素(OM)的混合液对食管瘢痕狭窄的预防作用及其安全性。方法选取2019年6月至2021年12月该院消化内镜中心收治并经胃镜及病理证实的食管高级别上皮内瘤变或黏膜内癌患者40例,所有患者均行ESD。依据系统随机化法将患者分为研究组与对照组(各20例),研究组术后创面喷洒硫糖铝凝胶与OM注射液的混合液,对照组术后创面喷洒硫糖铝凝胶。观察两组术后短期并发症发生情况;术后2个月随访观察创面愈合情况及临床症状,进行吞咽困难程度评分并计算食管再狭窄率;采用免疫组织化学法检测术后2个月创面瘢痕组织α-平滑肌肌动蛋白(α-SMA)表达水平。结果研究组术后并发症总发生率明显低于对照组(10.0%vs.45.0%,P<0.05)。术后2个月随访,研究组患者创面均完全愈合,未见溃疡,局部可见瘢痕形成,部分患者狭窄处黏膜皱襞向管腔中央聚集。对照组18例患者完全愈合,1例呈愈合期溃疡灶(H1期),1例为瘢痕期溃疡灶(S1期)。研究组吞咽困难程度评分[(1.842±1.112)分vs.(2.526±0.905)分]与食管再狭窄率(30.0%vs.65.0%)均明显低于对照组(P<0.05)。术后2个月,研究组创面瘢痕组织α-SMA表达水平明显低于对照组[(7.30±1.17)分vs.(10.46±1.87)分,P<0.05)]。结论局部使用硫糖铝凝胶联合OM有助于预防ESD后瘢痕狭窄的发生。Objective To investigate the preventive effect and safety of local spray of sucralfate gel and oxymatrine(OM)mixture on cicatricial stenosis of the esophagus in patients with early esophageal cancer after endoscopic mucosal dissection(ESD).Methods A total of 40 patients with high-grade intraepithelial neoplasia or intramucosal carcinoma confirmed by gastroscopy and pathology who were admitted to the Digestive Endoscopy Center of the hospital from June 2019 to December 2021 were selected,and all patients underwent ESD.They were divided into the study group and the control group(20 cases in each group)according to the systematic randomization method.The study group was sprayed with mixture solutions of sucralfate and OM injection on the wound after surgery,while the control group was sprayed with sucralfate gel on the wound after surgery.The occurrence of postoperative short-term complications was observed in the two groups.The wound healing and clinical symptoms were observed two months after the operation.Dysphagia score was performed and esophageal restenosis rate was calculated.The expression level ofα-smooth muscle actin(α-SMA)in scar tissue was detected by immunohistochemistry two months after surgery.Results The total incidence of postoperative complications in the study group was significantly lower than that in the control group(10.0%vs.45.0%,P<0.05).Two months after the operation,the wounds of the study group were completely healed,no ulcer was observed,local scar formation was observed,and the mucosal folds in the stenosis of some patients gathered toward the center of the lumen.In the control group,18 patients completely healed,one patient showed healing stage ulcer lesion(H1 stage),and one patient showed cicatricial stage ulcer(S1 stage).The dysphagia score[(1.842±1.112)vs.(2.526±0.905)]and esophageal restenosis rate(30.0%vs.65.0%)in the study group were significantly lower than those in the control group(P<0.05).Two months after the surgery,the expression level ofα-SMA in wound scar tissue in the

关 键 词：苦参素 内镜黏膜下剥离术 食管狭窄 瘢痕 纤维化 

分 类 号：R735.1[医药卫生—肿瘤]