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可回收支架对内镜下食管全周黏膜剥离术后食管狭窄的预防作用
周晓晴,张涛,陈龙,杜宗汉,胡小三,彭利红,李凤,于意文,罗荣枝,魏福霞
0
(南充市中心医院消化内科)
摘要:
【摘要】 目的 探讨食管环周内镜下黏膜剥离术(ESD)后预防食管狭窄的最佳方法。方法 选择24只贵州小型猪,将其分为ESD对照组、 试验组1(局部糖皮质激素黏膜下注射组)和试验组2(内镜下食管支架植入组),每组8只。选择猪食管中段即距门齿24~29cm进行环周ESD剥离。试验组1在食管环周ESD术后采用地塞米松注射液03mg/点环周注射;试验组2在食管环周ESD术后采用可回收覆膜支架植入,1月后胃镜下取出食管支架。ESD术后1周,2周,1月, 3月,6月评估三组试验猪的存活、体重变化、食管狭窄及胃镜通过情况。结果 ESD对照组在ESD术后1月食管明显狭窄,但部分胃镜镜身尚能通过。试验组1术后1月发生狭窄,但狭窄程度较ESD对照组轻。试验组2术后1月未发生狭窄。术后3月比较,ESD对照组狭窄明显增加,胃镜通过率仅约20%,试验组1狭窄也明显增加,胃镜通过率约40%,而试验组2虽发生狭窄,但胃镜通过率达到80%。术后存活比较:与ESD对照组比较,试验组1在术后1月无差异,术后6月存活明显增加;而试验组2在术后1月、3月和6月都明显增加(P<005)。术后体重比较:术后1月,ESD对照组及试验组1体重减轻,但试验组1无对照组减轻明显,试验组2体重明显增加;术后3月和6月比较,试验组2较试验组1试验猪体重明显增加(P<005)。结论 食管环周ESD术后局部地塞米松注射可减轻术后狭窄,并增加存活,然而狭窄和死亡率仍较高。食管环周ESD术后覆膜支架植入,并于1月后取出能明显减少食管患者ESD术后的狭窄,并明显增加存活,效果优于局部地塞米松注射。
关键词:  黏膜剥离术  食管环周  食管狭窄  局部注射  地塞米松  食管支架植入
DOI:
基金项目:南充市科学技术和知识产权局课题(16YFZJ0015)
Preventive effects of retrievable self expandable metal stent on esophageal stenosis in pigs with circumferential in esophageal endoscopic submucosal dissection
ZHOU Xiaoqing,ZHANG Tao,CHEN Long,DU Zonghan,HU Xiaosan,PENG Lihong,LI Feng,YU Yiwen,LUO Rongzhi,WEI Fuxia
(Department of Gastroenterology,Nanchong Central Hospital)
Abstract:
【Abstract】 Objective To explore the best method to prevent esophageal stricture after circumferential esophageal endoscopic submucosal dissection (ESD). Methods 24 Guizhou miniature pigs were divided into three groups including ESD control group, test group 1 (local injection of dexamethasone) and test group 2 (Esophageal stent implantation group). Circumference esophagus at 24 to 29 centimeters were dissected by ESD. Group 1 were carried out by local injection of dexamethasone 03 mg/point after ESD. Group 2 were carried out by implantation of retrievable selfexpandable metal stent, which was extracted after one month. Survival situation, body weight change, esophageal stricture and gastroscope passing were evaluated at first and second week, one month, 3 month and 6 months after ESD. Results After ESD in the first month, significant esophageal stricture was observed in the control group, remaining partial passing capacity for the gastroscope. Comparing to the control group, esophageal stenosis was also observed in the test group 1 with lighter symptom, since no significant esophageal stricture was observed in the test group 2. In the third month, the esophageal stricture had increased dramatically in the control group, with only 20% passing rate for the gastroscope. The symptom of esophageal stenosis in the test group 1 was also aggravated, with 40% passing rate left for the gastroscope. However, while esophageal stenosis was also observed, around 80% passing capacity remained for the gastroscope in the test group 2. For Postoperative survival comparison, comparing to the control group, the test group 1 had similar survival rate in the first month after ESD, but gained significantly increased survival rate in 6 months. And the test group 2 had gained higher survival rate in 1, 3 and 6 months after ESD (P<0.05) comparing to the control group. For postoperative body weight changes, weight loss had been observed in the test group 1, but lighter to the control group. And weight increasing had been observed in the test group 2 (P<0.05).Conclusion For test subjects with circumferential esophageal ESD, esophageal stricture would emerge in 1 month after the operation, mostly resulting in significant stenosis. With local injection of dexamethasone, the symptom can be alleviated and thus to contribute to a higher survival rate. However, the deteriorated rate could be still high and last for a high possibility to death. With esophageal retrievable self-expandable metal stent implantation, the rate of esophageal stricture can be significantly decreased with a dramatically increasing survival rate. And comparing to the method with local dexamethasone injection, the esophageal retrievable self-expandable metal stent implantation can gain better effectiveness in preventing the esophageal stricture after ESD.
Key words:  Endoscopic submucosal dissection  Circumferential esophagus  Esophageal stricture  Local injection  Dexamethasone  Esophageal retrievable self expandable metal stent implantation

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