Pelclová Daniela, Navrátil Tomás
Department of Occupational Medicine and Poisons Information Centre, First Medical Faculty and General Teaching Hospital, Charles University, Prague, Czech Republic.
Toxicol Rev. 2005;24(2):125-9. doi: 10.2165/00139709-200524020-00006.
The most serious complication of corrosive damage to the oesophagus besides perforation is stricture formation. The role of corticosteroids in preventing corrosive-induced strictures is controversial. This review evaluates the usefulness of corticosteroid treatment by critically assessing clinical reports published between 1991 and 2004 in the English, German, French and Spanish literature. Inclusion criteria were the presence of second- or third-degree oesophageal injuries documented by endoscopy and management involving either at least an 8-day course of corticosteroids or no steroid therapy. Ten studies with a total of 572 patients fulfilled the inclusion criteria: six studies employed corticosteroids, two studies did not use corticosteroids, and two studies compared the outcome with and without corticosteroid treatment. In those patients with second-degree burns, the incidence of stricture in the corticosteroid-treated patients was 13.8% and in the non-corticosteroid-treated patients was 6.3%. In those patients with third-degree burns, significantly worse results were found in the corticosteroid-treated group (71.0%) than in the non-corticosteroid-treated group (23.1%). As all studies did not separate second- and third-degree burns, re-analysis of the outcome was undertaken. In the 305 patients treated with corticosteroids, 35.1% developed strictures, whereas 33.3% of the 267 non-corticosteroid-treated patients developed strictures. These data suggest that systemic corticosteroids are not beneficial for second- and third-degree corrosive oesophageal burns. Therefore, the use of corticosteroids in the management of corrosive ingestions should be abandoned as they do not prevent the development of strictures and may lead to the development of serious adverse effects.
除穿孔外，腐蚀性食管损伤最严重的并发症是狭窄形成。皮质类固醇在预防腐蚀性狭窄方面的作用存在争议。本综述通过严格评估1991年至2004年间发表在英文、德文、法文和西班牙文文献中的临床报告，评估皮质类固醇治疗的有效性。纳入标准为经内镜证实存在二度或三度食管损伤，且治疗方案包括至少为期8天的皮质类固醇疗程或未使用类固醇治疗。共有10项研究、572例患者符合纳入标准：6项研究使用了皮质类固醇，2项研究未使用皮质类固醇，2项研究比较了使用和未使用皮质类固醇治疗的结果。在二度烧伤患者中，接受皮质类固醇治疗的患者狭窄发生率为13.8%，未接受皮质类固醇治疗的患者狭窄发生率为6.3%。在三度烧伤患者中，接受皮质类固醇治疗的组（71.0%）的结果明显比未接受皮质类固醇治疗的组（23.1%）差。由于所有研究均未区分二度和三度烧伤，因此对结果进行了重新分析。在305例接受皮质类固醇治疗的患者中，35.1%发生了狭窄，而在267例未接受皮质类固醇治疗的患者中，33.3%发生了狭窄。这些数据表明，全身性皮质类固醇对二度和三度腐蚀性食管烧伤无益。因此，在腐蚀性摄入物的治疗中应摒弃使用皮质类固醇，因为它们不能预防狭窄的发生，且可能导致严重不良反应的发生。
