一项比较巴雷特食管内科治疗与外科治疗的随机前瞻性研究的长期结果
Long-term results of a randomized prospective study comparing medical and surgical treatment of Barrett's esophagus.
作者信息
Parrilla Pascual, Martínez de Haro Luisa F, Ortiz Angeles, Munitiz Vicente, Molina Joaquín, Bermejo Juan, Canteras Manuel
机构信息
Department of Surgery, University Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain.
出版信息
Ann Surg. 2003 Mar;237(3):291-8. doi: 10.1097/01.SLA.0000055269.77838.8E.
OBJECTIVE
To compare the results of medical treatment and antireflux surgery in patients with Barrett's esophagus (BE).
SUMMARY BACKGROUND DATA
The treatment of choice in BE is still controversial. Some clinical studies suggest that surgery could be more effective than medical treatment in preventing BE from progressing to dysplasia and adenocarcinoma. However, data from prospective comparative studies are necessary to answer this question.
METHODS
One hundred one patients were included in a randomized prospective study, 43 with medical treatment and 58 with antireflux surgery. All patients underwent clinical, endoscopic, and histologic assessment. Functional studies were performed in all the operated patients and in a subgroup of patients receiving medical treatment. The median follow-up was 5 years (range 1-18) in the medical treatment group and 6 years (range 1-18) in the surgical treatment group.
RESULTS
Satisfactory clinical results (excellent to good) were achieved in 39 of the 43 patients (91%) undergoing medical treatment and in 53 of the 58 patients (91%) following antireflux surgery. The persistence of added inflammatory lesions was significantly higher in the medical treatment group. The metaplastic segment did not disappear in any case. Postoperative functional studies showed a significant decrease in the median percentage of total time with pH below 4, although 9 of the 58 patients (15%) showed pathologic rates of acid reflux. High-grade dysplasia appeared in 2 of the 43 patients (5%) in the medical treatment group and in 2 of the 58 patients (3%) in the surgical treatment group. In the latter, both patients presented with clinical and pH-metric recurrence. There was no case of malignancy after successful antireflux surgery.
CONCLUSIONS
These results show that there are no differences between the two types of treatment with respect to preventing BE from progressing to dysplasia and adenocarcinoma. However, successful antireflux surgery proved to be more efficient than medical treatment in this sense, perhaps because it completely controls acid and biliopancreatic reflux to the esophagus.
目的
比较巴雷特食管（BE）患者的内科治疗和抗反流手术的效果。
总结背景资料
BE的治疗选择仍存在争议。一些临床研究表明，在预防BE进展为发育异常和腺癌方面，手术可能比内科治疗更有效。然而，需要前瞻性对照研究的数据来回答这个问题。
方法
101例患者纳入一项随机前瞻性研究，43例接受内科治疗，58例接受抗反流手术。所有患者均接受临床、内镜和组织学评估。对所有接受手术的患者以及接受内科治疗的患者亚组进行功能研究。内科治疗组的中位随访时间为5年（范围1 - 18年），手术治疗组为6年（范围1 - 18年）。
结果
43例接受内科治疗的患者中有39例（91%）取得了满意的临床效果（优至良），58例接受抗反流手术的患者中有53例（91%）取得了满意的临床效果。内科治疗组附加炎性病变的持续存在率显著更高。化生节段在任何情况下均未消失。术后功能研究显示，pH值低于4的总时间中位数百分比显著降低，尽管58例患者中有9例（15%）出现病理性酸反流。内科治疗组43例患者中有2例（5%）出现高级别发育异常，手术治疗组58例患者中有2例（3%）出现高级别发育异常。在手术治疗组中，这2例患者均出现临床和pH值测量复发。抗反流手术成功后无恶性肿瘤病例。
结论
这些结果表明，在预防BE进展为发育异常和腺癌方面，两种治疗方法之间没有差异。然而，在这方面，成功的抗反流手术被证明比内科治疗更有效，可能是因为它能完全控制酸和胆胰液向食管的反流。
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