Preventive effect of Buyang Huanwu Decoction on esophageal stenosis after endoscopic submucosal dissection
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摘要: 目的 观察补阳还五汤联合激素对食管内镜黏膜下剥离术(ESD)患者术后食管狭窄的临床疗效。方法 选取77例食管ESD术后患者，随机分为实验组(n=38)和对照组(n=39)，对照组口服甲泼尼龙片，实验组口服补阳还五汤联合甲泼尼龙片，两组总疗程均为7周。比较治疗7周后、治疗结束第1、3、6个月后两组患者的Stooler吞咽困难分级、食管ESD术后溃疡分期、食管狭窄发生率及扩张次数。结果 治疗7周后，实验组的Stooler吞咽困难分级显著优于对照组，差异有统计学意义(P＜0.05)，治疗结束第1个月后两组患者的Stooler吞咽困难分级比较差异无统计学意义(P＞0.05)。治疗7周后，对照组38.5%的患者内镜下食管ESD术后溃疡分期为H期，61.5%为S期，实验组81.6%为H期，18.4%为S期，差异有统计学意义(P＜0.05)。治疗7周后，实验组食管狭窄的发生率小于对照组，差异有统计学意义(P＜0.05)；治疗结束第1个月两组的食管狭窄发生率比较差异无统计学意义(P＞0.05)。实验组患者进行扩张的次数明显低于对照组，差异有统计学意义(P＜0.05)。结论 口服补阳还五汤联合甲泼尼龙片干预食管ESD术后患者，可减少术后食管狭窄的发生，安全有效，值得推广。Abstract: Objective To observe the clinical efficacy of Buyang Huanwu Decoction combined with glucocorticoid on esophageal stenosis in patients after endoscopic submucosal dissection(ESD).Methods Seventy-seven patients after esophageal ESD were randomly divided into the control group(n=39) and the observation group(n=38). The control group was treated with methylprednisolone tablets, while the observation group was treated with Buyang Huanwu Decoction combined with methylprednisolone tablets. The total course of treatment was seven weeks. The Stooler grade, ulcer stage, rate of esophageal stenosis and dilation times were compared between the two groups after seven weeks of treatment, the 1stmonth, the 3rd month and the 6th month.Results After treatment, the Stooler grade of the observation group was significantly better than that of the control group(P < 0.05). In the control group, 38.5% of the patients were in H stage after ESD, while in the observation group that is 81.6%. The difference was statistically significant(P < 0.05). After treatment, the rate of esophageal stenosis in the control group was significantly lower than in the observation group(P < 0.05). The frequency of dilation in the observation group was significantly lower than in the control group(P < 0.05).Conclusion The treatment of Buyang Huanwu Decoction combined with glucocorticoid to interfere with scar formation after esophageal ESD is safe and effective and is worthy of promotion.
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表 1 两组患者的临床资料比较
例，X±S 组别 例数 性别 年龄/岁 病变部位/cm 切除范围/% 男 女 对照组 39 35 4 62.95±6.70 29.35±4.53 59.46±13.14 实验组 38 30 8 62.66±6.21 29.54±4.55 59.84±14.56 t/χ2 1.71 0.20 0.19 0.12 P 0.22 0.88 0.85 0.90 
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表 2 两组患者的观察指标比较
例(%)，M(Q1，Q3) 组别 例数 Stooler吞咽困难分级 治疗7周后溃疡分期 食管直径≤10 mm 扩张次数/次 治疗7周后 治疗结束1个月后 H期 S期 治疗7周后 治疗结束1个月后 对照组 39 1(0，2) 0(0，2) 15(38.5) 24(61.5) 8(20.5) 5(12.8) 0(0，2) 实验组 38 1(0，1) 0(0，1) 31(81.6) 7(18.4) 1(2.6) 1(2.6) 0(0，0) Z/χ2 2.72 0.96 14.88 4.36 1.54 2.17 P 0.01 0.34 ＜0.05 0.04 0.21 0.03
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表 3 两组患者的血液学指标比较
X±S 血液学指标 组别 治疗前 治疗后 t P 白细胞计数/(×109·L-1) 对照组 4.84±1.12 5.23±1.30 1.43 0.16 实验组 5.32±1.73 5.99±1.87 1.62 0.11 血小板计数/(×109·L-1) 对照组 186.33±60.16 189.95±73.64 0.24 0.82 实验组 192.45±59.48 196.63±60.62 0.30 0.76 谷丙转氨酶/(U·L-1) 对照组 22.54±13.61 22.62±11.74 0.03 0.98 实验组 21.07±12.51 21.86±13.93 0.26 0.80 谷草转氨酶/(U·L-1) 对照组 23.82±7.87 23.64±8.03 0.10 0.92 实验组 26.33±15.19 24.31±12.56 0.63 0.53 肌酐/(μmol·L-1) 对照组 66.66±9.66 65.96±10.46 0.31 0.76 实验组 65.54±14.56 65.49±12.73 0.01 0.99
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