病灶内注射曲安奈德治疗良性食管狭窄的有效性
Usefulness of intralesional triamcinolone in treatment of benign esophageal strictures.
作者信息
Kochhar Rakesh, Makharia Govind K
机构信息
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
出版信息
Gastrointest Endosc. 2002 Dec;56(6):829-34. doi: 10.1067/mge.2002.129871.
INTRODUCTION
The cornerstone treatment for benign esophageal strictures is endoscopic dilation. There are reports suggesting that intralesional corticosteroid injection decreases the frequency of endoscopic dilation.
METHODS
Seventy-one patients (mean age 42.39 [17.52] years; range, 13-78 years) with benign esophageal strictures (corrosive 29, peptic 14, anastomotic 19, radiation-induced 9) were recruited for this study. All were being managed with a program of intermittent endoscopic dilation by using over-the-wire polyvinyl dilators. All patients were treated by intralesional injections of triamcinolone acetonide (40 mg/mL diluted 1:1 with saline solution) by using a 23-gauge, 5-mm long sclerotherapy needle in aliquots of 0.5 mL. At each session, 4 injections (4 quadrants) were made at the proximal margin of the stricture with another 4 injections into the strictured segment itself whenever possible. The intervals between dilations and frequency of dilations were calculated before and after triamcinolone injections. A periodic dilation index (defined as number of dilations required per month) before and after the triamcinolone injections was calculated.
RESULTS
The overall mean (SD) duration of treatment before intralesional injection was 10.9 (19.8) months (range, 1-120 months) and the mean number (SD) of esophageal dilations required was 9.67 (13.06) (range, 1-70). The mean number of sessions of intralesional injection was 1.4 (0.62). After initiation of intralesional injections mean follow-up was 8.1 (5.6) months (range 3-30 months) and the mean number of esophageal dilations was 3.8 (3.0) (range 0-16). The periodic dilation index decreased significantly from 1.24 (0.05) (range 0.13-3.16) before injection to 0.5 (0.33) (range, 0-2) after injection (p < 0.001). For each category of stricture, the periodic dilation index decreased significantly: corrosive, 1.24 (0.5) to 0.53 (0.34) (p < 0.001); peptic, 0.92 (0.44) to 0.42 (0.2) (p < 0.001); anastomotic, 1.24 (0.49) to 0.51 (0.4) (p < 0.001); and radiation-induced, 1.32 (0.6) to 0.6 (0.3) (p < 0.02).
CONCLUSION
Intralesional injections of triamcinolone augment the effects of dilation in patients with benign esophageal strictures.
引言
内镜扩张是治疗良性食管狭窄的基石性疗法。有报告表明，病灶内注射皮质类固醇可降低内镜扩张的频率。
方法
本研究纳入了71例良性食管狭窄患者（平均年龄42.39[17.52]岁；范围13 - 78岁），其中腐蚀性狭窄29例，消化性狭窄14例，吻合口狭窄19例，放射性狭窄9例。所有患者均采用通过导丝聚乙烯扩张器进行间歇性内镜扩张的方案进行治疗。所有患者均使用23号、5毫米长的硬化治疗针，将曲安奈德（40毫克/毫升，用生理盐水1:1稀释）以0.5毫升的等分剂量进行病灶内注射。每次治疗时，在狭窄近端边缘进行4次注射（4个象限），并尽可能在狭窄段本身再进行4次注射。计算曲安奈德注射前后扩张间隔和扩张频率。计算曲安奈德注射前后的定期扩张指数（定义为每月所需扩张次数）。
结果
病灶内注射前治疗的总体平均（标准差）持续时间为10.9（19.8）个月（范围1 - 120个月），所需食管扩张的平均次数（标准差）为9.67（13.06）（范围1 - 70）。病灶内注射的平均次数为1.4（0.62）。开始病灶内注射后的平均随访时间为8.1（5.6）个月（范围3 - 30个月），食管扩张的平均次数为3.8（3.0）（范围0 - 16）。定期扩张指数从注射前的1.24（0.05）（范围0.13 - 3.16）显著降至注射后的0.5（0.33）（范围0 - 2）（p < 0.001）。对于每种类型的狭窄，定期扩张指数均显著下降：腐蚀性狭窄，从1.24（0.5）降至0.53（0.34）（p < 0.001）；消化性狭窄，从0.92（0.44）降至0.42（0.2）（p < 0.001）；吻合口狭窄，从1.24（0.49）降至0.51（0.4）（p < 0.001）；放射性狭窄，从1.32（0.6）降至0.6（0.3）（p < 0.02）。
结论
曲安奈德病灶内注射可增强良性食管狭窄患者的扩张效果。
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