聚乙醇酸网片联合口服激素对巨大早期食管癌内镜黏膜下剥离术后食管狭窄的预防作用

Preventive effect of polyglycolic acid sheet combined with oral glucocorticoid on esophageal stenosis after endoscopic submucosal dissection of large early esophageal cancer

摘要:

为了评估聚乙醇酸网片（polyglycolic acid sheet，PGA）联合口服激素用于巨大早期食管癌内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）后食管狭窄的预防作用，收集2013年1月至2024年3月间在华中科技大学同济医学院附属同济医院行ESD治疗，术后病理证实为早期食管癌，术后缺损≥3/4食管管周，采用单纯口服激素（单纯口服激素组，n=27）或PGA联合口服激素（PGA联合口服激素组，n=18）预防术后食管狭窄的45例病例纳入回顾性研究，对比分析发现：PGA联合口服激素组术后食管狭窄率明显低于单纯口服激素组［44.4%（8/18）比74.1%（20/27），χ2=4.034，P=0.043］，且≥3/4管周的非环周型食管缺损病例中，PGA联合口服激素组仅有1例［9.1%（1/11）］发生术后食管狭窄，而单纯口服激素组有10例［62.5%（10/16）］发生术后食管狭窄；在随访过程中，未观察到激素使用的严重并发症，也未观察到与PGA使用相关的不良事件。以上结果初步说明，PGA联合口服激素预防巨大早期食管癌ESD术后食管狭窄安全、有效，且预防效果优于单纯口服激素。

Abstract:

A retrospective study was conducted on data of 45 patients who underwent endoscopic submucosal dissection (ESD) at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2013 to March 2024 and were pathologically confirmed as having early esophageal cancer with postoperative defect ≥3/4 of the esophageal circumference, to evaluate the preventive effect of polyglycolic acid sheet (PGA) combined with oral glucocorticoid for esophageal stenosis after ESD of large early esophageal cancer. Patients were divided into two groups according to teatment: oral glucocorticoid alone group (n=27) and PGA combined with oral glucocorticoid group (n=18). The results showed that the postoperative esophageal stenosis rate was significantly lower in the PGA combined with oral glucocorticoid group compared with the oral glucocorticoid alone group [44.4% (8/18) VS 74.1% (20/27), χ2=4.034, P=0.043]. For cases of non-circumferential esophageal defects, only 1 case [9.1% (1/11)] experienced postoperative esophageal stenosis in the PGA combined with oral glucocorticoid group, while 10 cases [62.5% (10/16)] in the oral glucocorticoid alone group. During follow-up, no serious complications related to glucocorticoid use or adverse events related to PGA use were observed. These findings suggest that PGA combined with oral glucocorticoid is safe and effective for preventing esophageal stenosis after ESD for large early esophageal cancer and may be more effective than using only oral glucocorticoid.