博来霉素黏膜下注射联合内镜扩张治疗食管良性狭窄  

Submucosal injection of bleomycin combined with endoscopic dilation for the treatment of benign esophageal stricture

作　　者：王晨 李维勤 张佳玲[3] 刘莉 范志宁 吴瑞 WANG Chen;LI Weiqin;ZHANG Jialing;LIU Li;FAN Zhining;WU Rui(Digestive Endoscopy Department,the First Affiliated Hospital with Nanjing Medical University&Jiangsu Province Hospital,Nanjing 210029,Jiangsu,China;Department of Intensive Care Medicine,Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University/General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China;Department of Gastroenterology,the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University,Huaian 223300,Jiangsu,China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)消化内镜科,南京210029 [2]南京大学医学院附属金陵医院(东部战区总医院)重症医学科,南京210002 [3]南京医科大学附属淮安市第一人民医院消化内科,淮安223300

出　　处：《医学研究与战创伤救治》2024年第9期939-944,共6页Journal of Medical Research & Combat Trauma Care

基　　金：江苏省科技项目(BE2022704);南京市科技计划项目(202205052)。

摘　　要：目的探索博来霉素黏膜下注射联合内镜扩张对良性食管狭窄的治疗效果。方法回顾性分析2012年1月至2021年12月于江苏省人民医院消化内镜科行博来霉素黏膜下注射联合内镜扩张的良性食管狭窄患者120例(博来霉素组)的临床资料。按1∶1纳入同期行单纯内镜下扩张术的食管狭窄患者120例(单纯扩张组)。对2组患者的一般情况及短期(3个月)和长期(1年)的复发率、无吞咽困难期、扩张次数、吞咽困难评分等指标进行分析。对不同病因的食管狭窄患者及难治性食管狭窄患者进行亚组分析。最后,采用logistic回归探索博来霉素组患者复发的影响因素。结果与单纯扩张组相比,博来霉素组短期(34.2%vs 55.0%,P=0.001)及长期(71.7%vs 85.8%,P=0.008)复发率均显著改善。在良性食管狭窄的不同病因中,博来霉素对食管术后吻合口狭窄(短期:26.3%vs 46.1%,P=0.011;长期:64.5%vs 81.3%,P=0.020)及内镜黏膜下剥离术(ESD)术后狭窄(短期:61.1%vs 94.4%,P=0.016)的患者均有明显的益处。博来霉素组患者的无吞咽困难期较单纯扩张组显著提高[(2.8±2.2)个月vs(1.6±1.5)个月,P=0.044]。进一步多因素logistic回归分析提示,治疗前扩张次数(OR=0.157,P<0.001)、总扩张次数(OR=4.970,P<0.001)、治疗前吞咽困难程度(OR=3.053,P=0.007)是博来霉素组患者复发的影响因素。结论博来霉素黏膜下注射联合内镜扩张对食管狭窄患者的治疗效果显著优于单纯内镜扩张。Objective To explore the therapeutic effect of submucosal injection of bleomycin combined with endoscopic dilation on benign esophageal stricture(ES).Methods A retrospective analysis was conducted on 120 patients with benign ES who underwent submucosal injection of bleomycin combined with endoscopic dilation(bleomycin group)at the Department of Digestive Endoscopy,Jiangsu Province Hospital from January 2012 to December 2021.A comparison group of 120 patients with ES who underwent only endoscopic dilation during the same period(expansion group)were included at a 1∶1 ratio.General information,short-term(3 months)and long-term(1 year)recurrence rates,periods without dysphagia,number of dilations,dysphagia scores,and other indicators were analyzed.Subgroup analysis was conducted for patients with different etiologies of ES and for those with refractory esophageal stricture(RBES).Final ly,logistic regression was used to explore the influencing factors of recurrence in the bleomycin group.Results Compared with the expansion group,the bleomycin group showed significant improvements in short-term(34.2%vs 55.0%,P=0.001)and long-term(71.7%vs 85.8%,P=0.008)recurrence rates.Among different etiologies of benign ES,bleomycin significantly benefited patients with postoperative anastomotic stricture(short-term:26.3%vs 46.1%,P=0.011;long-term:64.5%vs 81.3%,P=0.020)and stricture after endoscopic submucosal dissention(ESD)(short-term:61.1%vs 94.4%,P=0.016).The duration without dysphagia in the bleomycin group was significantly longer than that in the expansion group(2.8±2.2 months vs 1.6±1.5 months,P=0.044).Further multivariate logistic regression analysis indicated that the number of dilations before treatment(OR=0.157,P<0.001),total number of dilations(OR=4.970,P<0.001),and pre-treatment dysphagia severity(OR=3.053,P=0.007)were influencing factors for recurrence in the bleomycin group.Conclusion Submucosal injection of bleomycin combined with endoscopic dilation is significantly more effective than single endoscopic dilation

关 键 词：博来霉素 食管 狭窄 扩张 

分 类 号：R571.1[医药卫生—消化系统]