Halsey Kevin D, Greenwald Bruce D
Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, MD 21201-1595, USA.
Gastrointest Endosc Clin N Am. 2010 Jan;20(1):75-87, vi-vii. doi: 10.1016/j.giec.2009.07.009.
Accumulating evidence highlights the promising results seen with endoscopic spray cryotherapy in the treatment of dysplasia associated with Barrett esophagus and esophageal carcinoma. Published studies show that the success of spray cryotherapy to eradicate Barrett high-grade dysplasia is comparable to that for other therapies, with a favourable safety profile and high levels of patient comfort. For patients with untreatable esophageal cancer, spray cryotherapy offers a therapeutic option with the potential for complete eradication in early-stage disease and palliation in advanced cases. The mechanism of tissue injury in cryotherapy is unique, with direct cytotoxic effects and ischemic effects from vascular injury. Increased tumor cell death through induction of apoptosis and immunologic effects require further study.
越来越多的证据表明，内镜喷雾冷冻疗法在治疗与巴雷特食管和食管癌相关的发育异常方面取得了令人鼓舞的成果。已发表的研究表明，喷雾冷冻疗法根除巴雷特高级别发育异常的成功率与其他疗法相当，具有良好的安全性和较高的患者舒适度。对于无法治疗的食管癌患者，喷雾冷冻疗法提供了一种治疗选择，在早期疾病中有可能实现完全根除，在晚期病例中则可实现姑息治疗。冷冻疗法中组织损伤的机制独特，具有直接的细胞毒性作用和血管损伤导致的缺血效应。通过诱导凋亡增加肿瘤细胞死亡以及免疫效应仍需进一步研究。
