激素浸泡和口服联用预防大面积食管病变内镜黏膜下剥离术后狭窄的短期疗效研究(含视频)  

Short-term efficacy of esophageal triamcinolone acetonide filling combined with oral methylprednisolone for prevention of esophageal stenosis after large-area endoscopic submucosal dissection (with video)

作　　者：王兰 范钦梅 金甜 张婷 毛丽娟 凌亭生 张其德 Wang Lan;Fan Qinmei;Jin Tian;Zhang Ting;Mao Lijuan;Ling Tingsheng;Zhang Qide(Digestive Endoscopy Center,Affiliated Hospital of Nanjing University of Chinese Medicine Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院、江苏省中医院消化内镜中心,南京210029

出　　处：《中华消化内镜杂志》2023年第8期623-629,共7页Chinese Journal of Digestive Endoscopy

基　　金：江苏省卫生健康委员会医学科研项目 (LKM2022003)。

摘　　要：目的探索并研究曲安奈德局部浸泡联合短疗程口服甲泼尼龙预防大面积食管病变内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)后食管狭窄的短期(≤3个月)有效性和安全性。方法纳入2021年6月—2022年9月期间在江苏省中医院消化内镜中心就诊的14例大面积早期食管病变患者(共15处病变),内镜下评估后患者均接受了食管ESD治疗。术后采用定期曲安奈德局部浸泡联合7周甲泼尼龙口服治疗,直至创面被再生鳞状上皮完全覆盖(>95%);若出现狭窄,则进行内镜下探条扩张术。主要观察食管狭窄率、首次内镜扩张距ESD完成的间隔时间、激素浸泡次数、ESD术后创面愈合时间、再生鳞状上皮生长速度及生长方式等;次要观察ESD术后出血、穿孔等不良事件及激素使用的相关不良事件。结果14例患者ESD术后无不良反应,均使用激素浸泡联合口服方案预防性治疗,有1例患者出现食管狭窄,狭窄发生率为7.1%(1/14);首次扩张距ESD完成的时间间隔为39 d,且只扩张1次。13例患者完成无狭窄鳞状上皮再生,且无相关激素并发症。中位激素浸泡次数6.5次(4.0~14.0次),中位创面愈合时间为40 d(32~94 d),中位愈合速度为0.61 cm^(2)/d(0.30~1.55 cm²/d)。结论激素浸泡联合短疗程口服方案在预防大面积食管ESD术后狭窄短期随访中具有一定的有效性和安全性。Objective To study the short-term(≤3 months)efficacy and safety of esophageal triamcinolone acetonide filling combined with short-course oral methylprednisolone for the prevention of esophageal stenosis after large-area endoscopic submucosal dissection(ESD)(≥3/4 circumference).Methods A total of 14 patients with 15 early esophageal lesions who received ESD after evaluation from June 2021 to September 2022 in Jiangsu Province Hospital of Chinese Medicine were enrolled.All received regular esophageal triamcinolone acetonide filling combined with oral methylprednisolone for 7 weeks until the lesions completely recovered by regenerated squamous epithelium(>95%).Patients with esophageal stricture were treated with additional endoscopic dilatation.The stenosis rate,the interval between the first endoscopic dilation and the completion of ESD,the number of esophageal triamcinolone acetonide filling,the healing time after ESD,and the speed and method of squamous epithelium regeneration were observed.The secondary observations were adverse events such as bleeding and perforation after ESD and adverse events related to steroid hormone.Results No adverse events occurred after ESD in 14 patients.Only 1 patient developed esophageal stenosis,the incidence of stenosis was 7.1%(1/14).The interval between the first dilation and ESD was 39 days.Thirteen patients achieved squamous epithelium regeneration without stenosis or adverse events related to steroid hormone.The median number of esophageal triamcinolone acetonide filling was 6.5 times(4.0-14.0 times),the median healing time was 40 days(32-94 days),and the median healing speed was 0.61 cm^(2)/d(0.30-1.55 cm²/d).Conclusion Esophageal triamcinolone acetonide filling combined with short-course oral methylprednisolone for the prevention of esophageal stenosis after large-area ESD is effective and safe in the short-term follow-up.

关 键 词：食管狭窄 内镜黏膜下剥离术 糖皮质激素 大面积 早期食管癌 

分 类 号：R735.1[医药卫生—肿瘤]