【摘要】 目的 探讨激素对食管癌内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)后狭窄预防的疗效，同时评估激素的治疗方案，并确定狭窄的危险因素。方法 回顾性分析2018年3月至2022年8月于重庆医科大学附属第二医院因早期食管癌接受ESD治疗的56例患者，其食管黏膜周长缺损大于50%,但不累及全周。患者分为四组，包括单纯ESD组(n=13)、口服激素组(n=28)、激素注射组(n=10)和激素联合治疗组(n=5)。进行Logistic回归分析，以评估食管狭窄的危险因素。结果 单纯ESD组、口服激素组、激素注射组和激素联合治疗组的狭窄率分别为53.8%、17.9%、30.0%和20.0%。使用激素治疗患者的狭窄率明显低于单纯ESD组(20.9%vs 53.8%,P=0.035)。此外，口服激素组的狭窄率显著低于单纯ESD组(P=0.029)。多因素分析显示，食管黏膜周长缺损的程度是ESD后狭窄的重要危险因素(OR=20.67,95%CI:2.35～182.00,P=0.006)。使用激素(OR=0.14,95%CI:0.03～0.67,P=0.014),特别是口服激素(OR=0.03,95%CI:0.00～0.66,P=0.027),与预防ESD后狭窄相关。结论 口服激素治疗对预防ESD后狭窄安全有效。与单纯口服激素相比，激素联合治疗并未改善狭窄预防效果，需要更多的多中心、前瞻性、随机对照研究进一步明确。更多还原

【Abstract】 Objective To investigate the efficacy of steroids in the prevention of stricture after endoscopic submucosal dissection(ESD) for esophageal cancer, also evaluate the treatment options of steroid, and to determine the risk factors for stricture. Methods Fifty-six patients who underwent ESD for early esophageal cancer at the Second Affiliated Hospital of Chongqing Medical University from Mar. 2018 to Aug. 2022 were retrospectively analyzed, and their mucosal defects were greater than the semi-circumference of the esophagus(>50%), but did not involve the whole circumference. Patients were classified into 4 groups, including ESD alone group(n=13), oral steroid group(n=28), steroid injection group(n=10), and steroids combination therapy group(n=5). Logistic regression analysis was performed to assess risk factors for esophageal stricture. Results The stricture rates were 53.8%, 17.9%, 30.0% and 20.0% in ESD alone group, oral steroid group, steroid injection group and steroids combination therapy group, respectively. Patients treated with steroids had a significantly lower rate of stricture than those treated with ESD alone group(20.9% vs 53.8%, P=0.035). In addition, the stricture rate was significantly lower in the oral steroid group than that in the ESD alone group(P=0.029). Multivariate Logistic analysis showed that the degree of circumferential mucosal defects was an important risk factor for stricture after ESD(OR=20.67, 95% CI: 2.35-182.00, P=0.006). Steroids use(OR=0.14, 95% CI: 0.03-0.67, P=0.014), particularly oral steroids(OR=0.03, 95% CI: 0.00-0.66, P=0.027), were related to the prevention of stricture after ESD. Conclusion Oral steroid therapy is a safe and effective method to prevent stricture after ESD. Compared with oral steroids, steroids combination therapy does not appear to improve stricture prevention, and more multicenter, prospective, randomized controlled studies are needed to further clarify.更多还原