Rosseneu S, Afzal N, Yerushalmi B, Ibarguen-Secchia E, Lewindon P, Cameron D, Mahler T, Schwagten K, Köhler H, Lindley K J, Thomson M
Royal Free Hospital, London, UK.
J Pediatr Gastroenterol Nutr. 2007 Mar;44(3):336-41. doi: 10.1097/MPG.0b013e31802c6e45.
Benign oesophageal strictures may occur as a complication of caustic ingestion or severe gastro-oesophageal reflux or as a sequela of oesophageal surgery and other fibrosing conditions. The traditional initial treatment of oesophageal strictures is intraluminal dilation; however, even if frequent, this occasionally may not provide adequate oesophageal lumen capacity or give significant symptom-free intervals, and restricturing after dilation is difficult and challenging. Topical postdilation application of an antifibrotic agent, mitomycin-C, in the treatment of an oesophageal stricture has been described.
Eight centres participated, with a total of 16 patients (4 girls), median age 48 (range 0-276) months. The causes of stricture were as follows: caustic (10), post-trachea-oesophageal fistula repair (2), peptic (2), Crohn disease (1), and dystrophic epidermolysis bullosa (1). The median (range) length and diameter of the strictures were as follows: 22 mm (8-50 mm) and 1.5 mm (1-6 mm). Of the 16 patients, 15 had undergone repeated dilations varying from 3 to more than 1000 (daily self-bouginage) before mitomycin-C, and the median interval between dilations was 4 weeks. Mitomycin-C 0.1 mg/mL was applied after dilation for a median time of 3.5 minutes and a median of 3 (1-12) times.
Major success, both endoscopic and clinical improvement or cure, occurred in 10 of 16 patients. In 3 of 16 patients the interval period between dilations increased dramatically. Failure of therapy was considered in 3 of 16. All of the patients remained symptom free for a follow-up time of as long as 5 years.
Postdilation application of topical mitomycin-C resulted in major success in 62.5% of patients and partial success in 19%, and it may be a useful strategy in oesophageal strictures of differing causes that are refractory to repeated perendoscopic dilation.
良性食管狭窄可能作为腐蚀性物质摄入、严重胃食管反流的并发症出现，也可能是食管手术及其他纤维化疾病的后遗症。食管狭窄的传统初始治疗方法是腔内扩张；然而，即便频繁进行扩张，有时仍无法提供足够的食管腔容量，也难以实现较长的无症状间期，且扩张后再狭窄的治疗困难且具有挑战性。已有文献报道在食管狭窄治疗中于扩张后局部应用抗纤维化药物丝裂霉素-C。
八个中心参与研究，共有16例患者（4名女孩），中位年龄4岁（范围0 - 276个月）。狭窄原因如下：腐蚀性物质所致（10例）、气管-食管瘘修补术后（2例）、消化性（2例）、克罗恩病（1例）以及营养不良性大疱性表皮松解症（1例）。狭窄的中位（范围）长度和直径如下：22毫米（8 - 50毫米）和1.5毫米（1 - 6毫米）。16例患者中，15例在使用丝裂霉素-C之前已接受3至1000多次（每日自行扩张）的反复扩张，扩张间隔的中位时间为4周。扩张后应用浓度为0.1毫克/毫升的丝裂霉素-C，中位时间为3.5分钟，中位应用次数为3次（1 - 12次）。
16例患者中有10例在内镜检查及临床方面均取得显著改善或治愈。16例患者中有3例扩张间期显著延长。16例中有3例被视为治疗失败。所有患者在长达5年的随访期内均无症状。
扩张后局部应用丝裂霉素-C使62.5%的患者取得显著成功，19%的患者部分成功；对于因不同原因导致的、经反复内镜扩张治疗无效的食管狭窄，这可能是一种有效的治疗策略。
