内镜下氩离子凝固术治疗Barrett食管118例临床分析

目的:探讨内镜下氩离子凝固术治疗Barrett食管的疗效。方法:经胃镜检查、病理证实的Barrett食管患者118例,在内镜下行氩离子凝固术治疗,术后给予质子泵抑制剂辅助治疗,于治疗后3,6,12个月进行复查,并对其疗效及并发症进行评估。结果:患者均完成治疗,92例首次治疗即全部清除病灶,余26例经2次治疗病灶完全清除。术后1年复查10例复发,复发率8.47%。术后17例(14.4%)出现胸骨后不适症状,9例(7.0%)出现胸骨后疼痛,给予质子泵抑制剂后缓解,3～7d症状消失;4例(3.1%)出现食管黏膜下气肿,自行吸收。结论:内镜下氩离子凝固术治疗Barrett食管安全、有效。     

氩离子凝固术联合质子泵抑制剂治疗 Barrett 食管32例疗效观察

目的:研究氩离子凝固术联合质子泵抑制剂治疗Barrett食管的疗效。方法:32例Barrett食管患者行氩离子凝固术,功率为60W,术后给予质子泵抑制剂治疗,在治疗后2~6个月复查胃镜,若病理提示仍有柱状上皮存在,再次进行氩离子凝固术治疗,直至Barrett食管黏膜完全消除。结果:胃镜下27例(84.4%)病灶消失,4例(12.5%)原病灶处可见岛状Barrett食管样改变,再次行氩离子凝固术,1例(3.1%)发现重度异型增生而行手术治疗。18例出现不同程度的胸骨后疼痛症状(56.3%),1例出现吞咽痛(0.3%),未见穿孔、狭窄等并发症发生。结论:氩离子凝固术联合质子泵抑制剂治疗Barrett食管是一种安全有效的方法。     

内镜下氩离子凝固术联合奥美拉唑治疗Barrett食管的临床观察

目的探讨Barrett食管（BE）病应用内镜氩离子凝固术和奥美拉唑药物疗法联合治疗及其临床效果与安全性。方法选取该院确诊的100例Barrett食管患者,根据年龄层次平均分为治疗组和对照组,2组各50例。对照组采用常规的奥美拉唑药物治疗方法,治疗组采用内镜下氩离子凝固术并联合奥美拉唑药物治疗,通过胃镜观察手术效果,对病灶清除不完全的患者日后进行二次氩离子凝固术。治疗结束后所有患者均进行4次定期胃镜复检,统计复检结果,对2组患者治疗情况进行数据分析与比较。结果分析2组患者复检数据,治疗1年以后检查结果,治疗组总有效率为88%,明显高于对照组总有效率（66%）,差异有统计学意义（P〈0.05）。安全性比较,对照组无不良反应,治疗组使用氩离子凝固术后6例患者有短期胸骨疼痛,在后续药物治疗过程中逐渐消失,对患者健康状况影响不大。结论内镜下氩离子凝固术联合奥美拉唑治疗Barrett食管,该临床治疗方案安全性好、有效率高,值得更深入长期的研究和临床推广。     

无痛胃镜下氩离子凝固术治疗Barrett食管21例分析

Barrett食管是食管下端的鳞状上皮被特殊肠化生的柱状上皮所替代的一种病理改变,是目前唯一公认的癌前病变[1].氩离子凝固术已证实能使Barrett食管黏膜消除,是治疗食管癌前病变的有效方法[2].但常规胃镜下治疗患者因紧张、恐惧而产生恶心、呕吐、食管蠕动频繁,导致视野不清、病灶治疗不彻底.本次研究采用无痛胃镜下氩离子凝固术治疗Barrett食管21例,效果满意.现报道如下.     

氩离子凝固术治疗Barrett食管的疗效观察

目的:观察氩离子凝固术治疗Barrett食管的疗效。方法:应用APC方法治疗Barrett食管患者,以药物治疗为对照,观察其疗效。结果:治疗组和对照组患者临床症状消失或明显缓解率无明显差异(P>0.05),内镜下表现及组织学表现差异有显著意义(P<0.05)。结论:氩离子凝固术联合抑酸治疗BE有效,治愈率高、安全。     

氩离子凝固术联合药物治疗Barrett食管的临床研究

目的探讨内镜下氩离子凝固术(argon plasma coagulation,APC)联合药物治疗Barrett食管(Barrett's esophagus,BE)的疗效。方法将90例BE患者按随机数字表法分为对照组和试验组各45例,试验组先给予单纯药物治疗8周(雷贝拉唑20 mg,bid,莫沙比利5 mg tid,铝碳酸镁片1 g tid),停药4周后复查胃镜,BE病灶仍存在者再行APC,术后服上述同样药物治疗;对照组先胃镜下行APC,术后再给予同样药物治疗。对于一次治疗不能清除病灶的患者,4周后进行第二次清除,直至病灶消失。两组APC均在无痛胃镜、窄带成像(NBI)及透明帽辅助下完成。于术后6、12、24个月进行NBI辅助下胃镜复查,对其疗效及并发症进行评估。结果试验组在单纯药物治疗3个月后胃镜下BE病灶未见明显改变;随访24个月,试验组镜下保持完全清除的BE食管患者占APC治疗的97.8%,明显高于对照组的77.8%(P<0.05)。两组临床症状缓解率(93.3%,86.6%)比较,差异无统计学意义,术后均无严重不良反应。结论单纯药物治疗虽不能消除BE黏膜病理改变,但可以缓解症状,减少APC后复发;先药物治疗2个月,再联合无痛胃镜下NBI及透明帽辅助下APC治疗BE疗效显著,有良好的临床应用前景。     

高频电凝联合雷贝拉唑及铝碳酸镁治疗岛型Barrett食管的疗效

目的:探讨高频电凝联合雷贝拉唑及铝碳酸镁治疗岛型Barrett食管的疗效.方法:选择电子胃镜及病理组织学检查确诊岛型Barrett食管患者65例,随机分为治疗组(31例)和对照组(34例).治疗组经胃镜行高频电凝治疗,术后联合雷贝拉唑及铝碳酸镁治疗;对照组用雷贝拉唑及铝碳酸镁治疗.所有病例于半年后复查胃镜及病理组织学检查.结果:半年后复查胃镜及病理组织学检查,治疗组治愈率及总有效率为93.55%及100%,对照组治愈率及总有效率为0及38.24%.两组治愈率及总有效率比较差异有显著性意义(P<0.01).结论:高频电凝联合雷贝拉唑及铝碳酸镁治疗岛型Barrett食管疗效显著、安全有效.     

内镜下氩离子凝固术治疗Barrett 食管13例疗效观察

对13例Barrett食管患者采用氩离子凝固术治疗,术后予奥美拉唑维持治疗。13例均完成治疗,其中11例患者治疗1次后Barrett黏膜完全消失,2例Barrett黏膜长度超过4cm的患者治疗2次后病灶完全消失。研究表明氩离子凝固术治疗Barrett食管操作简便,近期疗效显著,并发症少。     

氩离子凝固术联合泮托拉唑胶囊治疗Barrett食管疗效观察

目的观察氩离子凝固术联合泮托拉唑胶囊治疗Barrett食管的近期疗效。方法35例Barrett食管患者均应用60w氩气刀行氩离子凝固术（argonplasmacoagulation,APC）治疗,并在术后给予泮托拉唑胶囊40mg／次,1次／d,口服,连续服用1个月,分别于术后1,6,12个月行胃镜检查评定疗效,观察不良反应发生情况。结果APC治疗后患者Barrett黏膜均可完全消除,其中1次治疗消除26例,2次治疗消除7例,3次治疗消除2例;治疗后24h出现胸骨后不适感15例,烧灼感、反酸、恶心1例,服用泮托拉唑胶囊后症状消失;1例长段Barrett食管12个月后复发。结论APC联合泮托拉唑胶囊治疗Barrett食管安全、有效。     

内镜下氩离子凝固术加埃索美拉唑治疗舌型及岛型短段Barrett’s食管的临床研究

目的探讨内镜下氩离子凝固术(APC)加埃索美拉唑治疗舌型及岛型SSBE疗效及安全性。方法内镜及病理检查确诊为舌型或岛型的SSBE患者45例随机分为两组,治疗组24例行内镜下APC加埃索美拉唑治疗,对照组21例单纯给予口服埃索美拉唑治疗,分别于治疗后3,6,9及12个月复查胃镜并取活检送病理检查。治疗组中复查胃镜未达显效的患者,再行镜下APC治疗并继续口服埃索美拉唑治疗4周。结果治疗组患者治疗后3,6,9及12个月总有效率均为100%,平均显效率为87.5%,与对照组(30.5%,6.1%)相比较,差异具有显著性(P<0.01);治疗组未出现出血、穿孔、食管狭窄等相关并发症。结论内镜下APC联合埃索美拉唑治疗SSBE疗程短,安全有效,并发症少。     

Barrett食管的氩离子凝固术或激光治疗

复习国外氩离子凝固术 (Argonplasmacoagulation ,APC)或激光治疗Barrett食管的有关文献资料结果表明 :APC联合高剂量奥美拉唑或腹腔镜抗反流术治疗BE安全、有效 ;单用激光或联合奥美拉唑治疗Barrett食管 (Barrett’sesopha gus ,BE)患者的肠化上皮消失。因此APC或激光可用于BE的治疗     

Barrett食管的治疗研究及p53在治疗前后的表达

目的：研究不同方法治疗Barrett食管（BE）患者的疗效，并通过检测治疗前后食管中p53的表达改变．探索各种治疗方法产生效果的可能机制。方法：经胃镜及活检确诊的BE患者75例，随机分为5组进行治疗。（1）对照组（A组），不进行特殊治疗；（2）抑酸药组（B组），口服奥美拉唑20mg，每日2次。（3）胆汁吸附剂组（C组）．口服铝碳酸镁1000mg，每日3次。（4）抑酸药＋胆汁吸附剂组（D组），口服奥美拉唑及铝碳酸镁，用法用量同B、C组。（5）氩气凝固术（APC）＋抑酸药及胆汁吸附剂组（E组），在D组治疗基础上对BE患者行内镜下APC治疗。各组均治疗3个月。治疗前、治疗后1个月及3个月后观察并记录临床症状及内镜下表现，取得食管黏膜组织标本行病理学检查．并采用SABC免疫组化染色检测食管上皮中p53的表达情况。结果：3个月后各治疗组的症状均较治疗前明显减轻，与A组相比均有统计学差异（P〈0．05）；各治疗组间相比，症状缓解率无明显差异（P〉0．05）。内镜检查发现。A、B、C、D组的BE黏膜均未见明显变化，而E组能使91％的患者BE黏膜消除。D、E组治疗后食管p53表达均较治疗前显著降低，与A组相比有统计学差异（P〈0．05），E组改变比D组更显著。各治疗组均未发现严重不良反应。结论：抑酸药和（或）胆汁吸附剂不能使BE逆转，但可消除临床症状并可改变BE中p53的表达。APC＋抑酸药及胆汁吸附剂方案可以消除症状。也可消除BE黏膜。安全性好，可降低p53的表达，是治疗BE的一种合理可行、有效实用的方法。p53的表达可作为判定治疗效果的可能指标。     

Local treatment of early cancer in short Barrett's esophagus by means of argon plasma coagulation: initial experience.

In recent years endoscopically controlled local therapeutic methods, such as photodynamic therapy, mucosectomy, or laser therapy, have been used with a curative aim for the destruction of early esophageal or gastric cancers. We report on our experience of treating histologically proven mucosal cancer in Barrett's esophagus with argon plasma coagulation (APC), in three patients. All the mucosal esophageal cancers, with a mean diameter of 4 mm, were successfully destroyed after one or two treatment sessions. Additionally, in two of the three patients the specialized columnar epithelium was replaced by normal squamous cell epithelium when APC treatment was combined with omeprazole. In the third patient with Barrett's esophagus, a partial squamous cell re-epithelialization was induced. No method-related mortality and morbidity were observed. During the mean follow-up of 24.3 +/- 1.1 months (range 23-25 months) one tumor recurrence developed which was successfully treated with photodynamic therapy. In patients with small early Barrett's carcinoma APC might offer an effective, minimally invasive alternative to mucosectomy or photodynamic therapy, as the treatment procedure is less cumbersome and the equipment less expensive.     

Intraepithelial high-grade neoplasia and early adenocarcinoma in short-segment Barrett's esophagus (SSBE): curative treatment using local endoscopic treatment techniques

BACKGROUND AND STUDY AIMS: In recent years, short-segment Barrett's esophagus (SSBE) has attracted increasing attention in the context of reflux disease. However, there is continuing controversy regarding its potential for malignant transformation. PATIENTS AND METHODS: Between October 1996 and September 1999, 50/115 patients (43 %) with intraepithelial high-grade neoplasia or early Barrett's adenocarcinoma, who underwent local endoscopic treatment, had developed a malignant lesion in an (SSBE). In the framework of a prospective observational study, 28 patients were treated with endoscopic mucosal resection (EMR), 13 with photodynamic therapy, and three with argon plasma coagulation; six patients received combinations of these treatments. RESULTS: Complete local remission was achieved in 48/49 patients (98 %). One patient switched to surgery after the first EMR, because there was submucosal tumor infiltration, and in one patient out of 50 local endoscopic treatment failed. A mean of 1.7 +/- 1.4 treatment sessions was required for local endoscopic treatment. The method-associated mortality was 0 %. The rate of relevant complications (stenosis, bleeding) was 6 % (3/50 patients). No cases of severe hemorrhage (Hb fall >2 g/dl) or perforation occurred. During a mean follow-up period of 34 +/- 10 months, metachronous intraepithelial high-grade neoplasms or early adenocarcinomas were seen in 11/48 patients (23 %), who received further successful endoscopic treatment. Four patients died during the follow-up period, but in only one patient was this due to his Barrett's adenocarcinoma (this was the patient who underwent esophageal resection). CONCLUSIONS: The malignant potential of short-segment Barrett's esophagus must not be underestimated. Organ-preserving local endoscopic treatment shows good acute-phase and long-term results. Local endoscopic treatment represents an alternative to esophageal resection in the case of intraepithelial high-grade neoplasia and selected early adenocarcinomas in Barrett's esophagus.     

Long-term follow-up and factors predictive of recurrence in Barrett's esophagus treated by argon plasma coagulation and acid suppression

BACKGROUND AND STUDY AIMS: In several series, argon plasma coagulation (APC) combined with acid suppression has led to short- or medium-term eradication of Barrett's esophagus. The present study was designed to assess the long-term outcome after this treatment. PATIENTS AND METHODS: 39 patients with Barrett's esophagus, seven of them with low-grade dysplasia, underwent APC and received 40 mg omeprazole daily for eradication of the metaplastic epithelium. After the treatment period, patients were randomly assigned to receive 20 or 40 mg omeprazole daily for long-term acid suppression. Histological and endoscopic changes were evaluated annually. Univariate and multivariate analyses were used to test the following 10 variables as predictors of sustained reversal of Barrett's esophagus at the end of follow-up: age, gender, length of diseased segment, presence of hiatal hernia, circumferential nature of lesion, presence of low-grade dysplasia at initial biopsy, number of coagulation sessions, result of pH monitoring under protein pump inhibitor (PPI) treatment, omeprazole dosage, and initial response to therapy (after 1 month). RESULTS: The median follow-up period was 36 months (range 12 - 48). The endoscopic and histological relapse rates at 1, 12, and 24 months, and end of follow-up were, respectively, 30 % and 44 % (12/39 and 17/39), 57 % and 54 % (16/28 and 15/28), 60 % and 57 % (17/28 and 16/28), and 62 % for both rates (23/37). According to multivariate analysis, shorter length of diseased segment and normalization of pH with PPI treatment were the only independent predictors of sustained long-term re-epithelialization. Among the seven patients with low-grade dysplasia, four experienced relapse after 1 month, and during the long-term follow-up, one was lost to follow-up and all the others experienced relapse, but only one developed low-grade dysplasia again. Cancer was found in two cases after 12 and 18 months, respectively. CONCLUSIONS: Persistence of acid reflux and greater length of diseased segment are the major factors associated with a high relapse rate after successful initial reversal. APC for ablation of Barrett's esophagus cannot be recommended.     

Argon plasma coagulation in Barrett's esophagus

Argon plasma coagulation (APC) is noncontact electrocoagulation technique that creates tissue damage. Recently, it has been reported that Barrett's esophagus and Barrett's adenocarcinoma in situ could be successfully managed by APC. The aims of this treatment are to prevent the developing of adenocarcinoma and to promote the restitution of normal squamous epithelium. Combined antireflux surgery or proton pump inhibitor therapy are indispensable to this treatment. Shorter length of Barrett's epithelium and normalization in pH with PPI treatment were the independent predictors of sustained long-term restitution of squamous epithelium. In patient with Barrett's esophagus, APC offers an effective, minimally invasive alternative to other treatments previously performed.     

氩离子凝固术联合抑酸治疗Barrett食管的临床研究

目的：探讨内镜下氩离子凝固术（APC）联合抑酸治疗对Barrett食管的临床疗效。方法：选择经内镜及病理确诊的Barrett食管患者40例,随机分为两组,治疗组21例,对照组19例,治疗组经内镜下APC治疗后联合埃索美拉唑20mg2次／日连续3月,对照组单用埃索美拉唑20mg2次／日连续3月,分别于3月、6月、12月对两组进行临床症状积分和内镜及病理随访。结果：两组治疗后3、6、12月临床症状积分缓解无明显差异性（P〈0．05）,但从内镜、病理随访的有效率来看,治疗组与对照组相比有显著差异性（P〈0．05）。结论：BE内镜下APC联合抑酸治疗能有效逆转Barrett上皮,是一种安全、有效的治疗方法。     

氩离子凝固术联合埃索美拉唑治疗Barrett食管疗效观察

目的 对氩离子凝固术联合埃索美拉唑治疗Barrett食管(BE)近期疗效进行评价.方法 选择40例BE患者,采用随机数字表法分为埃索美拉唑治疗组(单纯药物组)和氩离子凝固术联合埃索美拉唑治疗组(联合治疗组),2组基线资料均衡.3、6、12个月分别随访,对其临床症状缓解情况和消除与复发情况进行评价.结果 12个月联合治疗组治疗满意率明显高于单纯药物组( 85.0％ vs 55.0％,P＜0.05).在联合治疗组中,氩离子凝固术对短段BE治愈率达100％,2例长段BE在6个月时复发;未出现严重溃疡、出血和穿孔等并发症.单纯药物组未见病灶消除.结论 氩离子凝固术联合埃索美拉唑治疗BE是安全有效的治疗方法.     

药物治疗前后Barrett食管Cox-2与Ki-67的表达

目的：研究不同方法治疗Barrett食管患者的疗效，探索各种治疗方法产生效果的可能机制，为Barret食管的治疗提供理论支持及指导。方法：经胃镜及活检确诊的Barret食管患者55例，随机分为4组进行治疗，（1）A组：未给予治疗；（2）B组：口服奥美拉唑20mg，2次／d；（3）C组：口服铝碳酸镁1000mg，3次／d；（4）D组：口服奥美拉唑20mg，2次／d，铝碳酸镁1000mg，3次／d。治疗前、治疗后1个月及3个月后观察临床症状及内镜下表现，取得食管黏膜组织标本行病理学检查，采用SABC免疫组化染色检测食管上皮中Cox-2、Ki-67的表达情况，并进行组间及治疗前后比较。结果：在缓解临床症状方面，各治疗组的症状均较治疗前明显改善，与对照组相比差异均有统计学意义（P〈0．05）；各治疗组相比，症状缓解率差异无统计学意义（P〉0．05）。对照组和药物治疗组的Barret食管黏膜均未见明显缩小。各治疗组的食管标本中，Cox-2、Ki67的表达均显著降低，与对照组相比差异有统计学意义（P〈0．05）。结论：抑酸药和／或胆汁吸附剂不能使Barret食管逆转，但可消除临床症状并可改变BE食管Cox2与Ki67的表达。