曲安奈德局部注射治疗食管癌(早期)ESD术后食管狭窄的临床研究

目的观察曲安奈德局部注射对早期食管癌ESD术后食管狭窄的影响。方法选取102例食管癌ESD术后良性狭窄的患者,采用随机数表法分为观察组与对照组,各51例。对照组采取胃镜下探条扩张治疗,观察组在扩张后立即黏膜下注射曲安奈德。比较两组治疗前与治疗后4周的Stooler分级、总有效率、并发症总发生率。术后随访6个月,比较两组进展为Stooler3级的时间、随访期间再次扩张治疗的次数及扩张间隔时间。结果两组治疗前后的Stooler分级均无统计学意义(P 0. 05)。术后4周观察组总有效率为94. 12%,对照组为88. 24%,差异无统计学意义(P 0. 05)。观察组与对照组术后并发症总发生率分别为25. 49%和21. 57%,差异无统计学意义(P 0. 05)。两组随访6个月期间所有患者均最终进展为Stooler3级。观察组进展为Stooler3级的时间、扩张间隔时间分别为(20. 32±3. 54)周与(16. 74±3. 94)周,均显著长于对照组(16. 28±3. 00)周与(13. 55±3. 77)周,随访期间再次扩张治疗次数为(1. 52±0. 64)次,显著少于对照组(2. 01±0. 76)次(P 0. 05)。结论内镜下探条扩张联合局部注射曲安奈德治疗早期食管癌ESD术后食管狭窄可有效抑制瘢痕组织纤维增生及胶原合成,减少再狭窄及再治疗,安全有效,值得推广。     

曲安奈德球内注射治疗黄斑水肿效果观察（附25例报告）

目的观察曲安奈德球内注射治疗黄斑水肿的效果。方法50例黄斑水肿患者随机分为常规组（常规药物治疗＋激光治疗）和观察组（曲安奈德球内注射治疗）,各25例。比较两组视力、黄斑厚度、治愈率。结果观察组治疗后视力为0．66±0．21、黄斑中央厚度（320±63）μm,治愈率为92％;常规组分别为0．45±0．06、（400±21）μm和72％（P均〈0．05）。结论与常规治疗比较,曲安奈德球内注射治疗黄斑水肿疗效可靠。     

曲安奈德皮损内注射联合放疗治疗瘢痕疙瘩的疗效观察

目的观察曲安奈德皮损内注射联合放疗治疗瘢痕疙瘩的临床疗效。方法将60例瘢痕疙瘩患者随机分为两组,A组采用曲安奈德40~80 mg皮损内注射,每4周1次,至瘢痕疙瘩变软、变平;最后一次注射后1周内行局部6 M eV电子线外照射,共1 600~2 000 cGy;B组行单纯曲安奈德皮损内注射,方法同A组,瘢痕疙瘩变平、变软后加强1次。结果 A、B组总有效率分别为87.23%、79.59%,治愈率分别为55.32%、34.69%,两组治愈率比较有统计学差异（P〈0.05）。结论曲安奈德皮损内注射联合放疗治疗瘢痕疙瘩疗效确切,其疗效优于单纯曲安奈德皮损内注射治疗。     

倍剂泮托拉唑联合多潘立酮治疗胃食管反流病的临床研究

目的 探讨倍剂泮托拉唑联合多潘立酮治疗胃食管反流病（GERD）的临床疗效。方法 210例GERD病人随机分为三组：A组为倍剂泮托拉唑联合多潘立酮、B组为常规剂量泮托拉唑联合多潘立酮、C组为常规剂量泮托拉唑，各组均为70例。治疗4周后，评价各组临床症状缓解情况和内镜下的表现。结果 治疗4周后A组、B组、C组的症状缓解总有效率分别为92．85％、74．28％、70．00％（均为P〈0．05）；治疗4周后内镜下病变改善率分别为88．57％、72．85％、51．42％（均为P〈0．05）；A组轻、中、重度病例临床症状缓解总有效率分别为95．65％、93．33％、88．24％；B组为91．30％、73．33％、52，94％；C组为87．00％、70．00％、47，06％。轻度GERD患者三组治疗总有效率比较差异无显著性。中度、重度患者A组与B组、A组与C组治疗总有效率相比较有显著性差异（P〈0.05）。结论 应用倍剂泮托拉唑联合多潘立酮治疗胃食管反流病，可使患者症状迅速改善，病变治愈率高，对中、重度GERD疗效显著。无不良反应，可推广使用。     

恶性肿瘤化疗与联合放化疗动态心电图对比分析

目的了解化疗及放化疗期间恶性肿瘤患者出现心慌、心悸等症状时心电图的改变。方法对尚未治疗组（A组）、化疗组（B组）及放化疗组（C组）恶性肿瘤患者在治疗期间出现心慌、心悸等症状时作24h动态心电图（DCG）,对其心率、期前收缩、异位心动过速及ST—T改变等进行对比分析。结果24h最高心率、最低心率、平均心率及24h总心率,B、c组与A组比较具有非常显著性差异（P〈0．01及O．001）。B与C组间平均心率、24h总心率有显著性差异（P〈0．05）,但最高心率、最低心率无显著性差异（P〉0．05）。〉100次／24h房性及室性期前收缩,A与B组间具有显著性差异（P〈0．05）,A与C组间具有非常显著性差异（P〈0．01）。B与C组间房性期前收缩具有显著性差异（P〈0．05）,但室性期前收缩无显著性差异（P〉0．05）。A与B及A与C组间短阵性房性心动过速具有非常显著性差异（P〈0．01）,但B与C组间无显著性差异（P〉0．05）。室性心动过速三组间无显著性差异（P〉0．05）。A与C组间ST—T改变具有非常显著性差异（P〈0．01）,但A与B及B与C间无显著性差异（P〉0．05）。结论化疗、放疗对心脏具有一定毒性作用,联合放化疗可加重二者的毒性作用。动态心电图可作为在化疗、放化疗时,对有症状性肿瘤患者的心脏毒性作用最简捷的监测方法,有利于临床医生及时调整方案。     

脑室穿刺引流联合脑脊液置换术治疗重型脑室出血的疗效评价

对90例重型脑室出血患者随机进行开颅清除血肿（A组），脑室穿刺引流（B组）和脑室穿刺引流联合脑脊液置换术治疗（C组），分析评价3种手术方法的疗效。结果：3组治疗后临床神经功能缺损程度评分较治疗前均有显著降低（P〈0．05）IB、C组的总有效率和基本痊愈率高于A组，脑脊液正常时间、住院天数较A组明显缩短，病死率低于A组（P〈0．05），而B、C组间无显著性差异（P〉0．05）IC组的基本痊愈率高于A、B组（P〈0．05）。认为脑室穿刺引流联合脑脊液置换术治疗重型脑室出血可以有效降低病死率，提高治愈率，是治疗重型脑室出血的有效方法。     

稳心颗粒与胺碘酮联用治疗老年冠心病室性心律失常的临床研究

目的观察稳心颗粒与胺碘酮联用治疗老年冠心病室性心律失常的疗效。方法将89例冠心病随机分为稳心颗粒加胺碘酮组（A组）34例、胺碘酮组（B组）29例、稳心颗粒组（C组）26例，观察治疗前后临床症状和心律失常改善情况及不良反应。结果治疗前后动态心电图观察对比：A组总有效率为91．18％（31例），B组总有效率为68．96％（20例），C组总有效率为69．23％（18例）。A组与B组比较P〈0．05差异有显著性，与C组比较亦有显著性差异（P〈0．05），B组与C组比较P〉0．05，无显著性差异；治疗后临床症状改善情况：A组与B组比较、与C组比较均P〈0．05，差异有显著性；B组与C组比较则无显著性差异（P〉0．05）。结论稳心颗粒与胺碘酮联用治疗治疗老年冠心病室性心律失常明显优于各自单用疗效，且不良反应少。     

不同方法治疗Barrett食管的疗效观察

目的比较不同方法治疗Barrett食管（BE）的疗效。方法将75例BE患者随机分为A、B、C、D组和对照组。A组口服奥美拉唑；B组口服铝碳酸镁；C组口服奥美拉唑＋铝碳酸镁；D组行氩气凝固术（APC）＋口服奥美拉唑及铝碳酸镁；对照组未行特殊治疗。比较五组患者治疗前后的临床、病理、内镜表现及食管上皮Ki-67水平。结果各治疗组临床症状均明显改善（P〈0．05），组间比较无统计学差异（P〉0．05）；A、B、C组及对照组BE黏膜均未见明显缩小，D组91．3％的患者BE黏膜恢复正常；各治疗组Ki-67表达均低于对照组，D组低于A、B组（P均〈0．05）。结论APC＋奥美拉唑、铝碳酸镁方案可改善BE患者的临床症状、BE黏膜，降低Ki-67表达，安全性好，为BE的理想治疗方案。     

超声引导下局部注射MTX联合中药口服治疗植入性胎盘疗效观察（附20例报告）

目的观察超声引导下经腹胎盘组织局部注射氨甲蝶呤（MTX）配合口服中药逐盘颗粒治疗植入性胎盘的疗效。方法将36例植入性胎盘患者随机分为A组20例、B组16例。均在超声引导下经腹向植入的胎盘组织内注射NTX,A组加服逐盘颗粒,1个月为1个疗程,共3个疗程。结果A组治疗总有效率为90．00％,高于B组的62．50％（P〈0．05）;A组血清β-HCG降至正常时间为（41．92±31．56）d,胎盘排出时间为（34．21±9．46）d,注射MTX（1．50±0．69）次;B组分别为（67．31±42．95）d、（51．62±11．45）d、（2．19±0．83）次（P均〈0．05）。结论超声引导下经腹胎盘组织局部注射MTX配合口服逐盘颗粒治疗植入性胎盘效果好、安全,值得推广应用。     

奥曲肽联合奥美拉唑治疗肝硬化上消化道出血的疗效观察

目的观察奥曲肽联合奥美拉唑治疗肝硬化上消化道出血的疗效。方法将66例肝硬化上消化道出血患者分为A组（36例）和B组（30例）,A组采用奥曲肽和奥美拉唑联合治疗,B组单用奥曲肽治疗,观察止血情况。结果A组48h再出血率（10．20％）明显低于B组（27．66％,P〈0．05）;A组住院天数5．1±2．4天,明显少于B组7．5±2．8天（P〈0．05）;A组输血量3．5±2．2U,与B组3．7±2．1U比较无明显差异（P〉0．05）;A、B两组病死率A组为2．78％,B组为3．33％,无明显差异,（P〉0．05）。结论奥曲肽联合奥美拉唑治疗肝硬化上消化道出血,能有效地止血,并预防再出血发生和缩短住院天数。     

Refractory strictures post‐esophageal atresia repair: what are the alternatives?

Esophageal strictures remain the most frequent complication after esophageal atresia (EA) repair despite refinements in operative techniques. With an incidence of anastomotic stricture between 8% and 49%, EA is the most frequent cause of benign esophageal stricture in children. The mainstay of treatment for esophageal stricture is dilatation with a 58–96% success rate. In order to relieve dysphagia, between 1 and 15 dilatations will be required in each EA patient with an esophageal stricture. However dilatations may lead to complications including perforation (0.1–0.4% of all esophageal benign strictures) and sociopsychological morbidity. Fifty percent of EA strictures will improve in 6 months. However, 30% will persist and require repeat dilatations. The present article explores the variety of non‐surgical alternative treatments for anastomotic strictures after EA repair, focusing on triamcinolone acetonide, mitomycin C and esophageal stents. We propose an algorithm for a more standardized therapeutic approach, with the hope that an international panel of experts could meet and establish a consensus.     

Aggressive bougie dilatation and intralesional steroids is effective in refractory benign esophageal strictures secondary to corrosive ingestion

Endoscopic dilatation of corrosive esophageal strictures is effective, but some patients are refractory to it and require long‐term repeated dilatations. The present study was carried out to analyze whether rigorous schedule of endoscopic bougie dilatation along with intralesional injection of triamcinolone in patients refractory to endoscopic dilatation alone could decrease the number and frequency of endoscopic dilatations. The inclusion criterion for this prospective study was patients with refractory corrosive esophageal stricture of any age group. Refractory benign esophageal stricture is defined as an anatomic fibrotic esophageal restriction with inability to achieve dilatation of ≥14 mm or to maintain dilatation for 4 weeks once ≥14 mm diameter is achieved. The patients were followed up prospectively for 1 year. Patients with refractory strictures were subjected to weekly bougie dilatation (Savary‐Gilliard) of the strictures along with injections of intralesional triamcinolone (40 mg/mL, 1 mL diluted in 1 mL of saline, 0.5 mL injected per quadrant of stricture) for consecutive 5 weeks, referred to as rigorous schedule. Further dilatation was done on an ‘on‐demand’ basis. Eleven patients were enrolled for the study. Dysphagia score improved from pre‐intervention score of 3.54 ± 0.52 to 0.45 ± 0.52 post‐intervention (P < 0.001). The maximum dilatation achieved pre‐intervention was 9.90+1.04 mm Savary‐Gilliard and post‐intervention significantly improved to 14.7 + 0.7 mm Savary‐Gilliard (P < 0.001). The periodic dilatation index defined as number of dilatations per month also significantly improved from pre‐intervention score of 2.54 ± 1.06 to post‐intervention score of 0.19 + 0.13 (P < 0.001). No adverse effects were reported by the patients. Rigorous weekly schedule of bougie dilatation and intralesional triamcinolone in combination is safe and effective in achieving significant dilatation, reducing the frequency dilatations, maintaining dilatation and improving dysphagia till 1 year of follow‐up.     

Prevention of esophageal strictures after endoscopic submucosal dissection

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have recently been accepted as less invasive methods for treating patients with early esophageal cancers such as squamous cell carcinoma and dysplasia of Barrett’s esophagus. However, the large defects in the esophageal mucosa often cause severe esophageal strictures, which dramatically reduce the patient’s quality of life. Although preventive endoscopic balloon dilatation can reduce dysphagia and the frequency of dilatation, other approaches are necessary to prevent esophageal strictures after ESD. This review describes several strategies for preventing esophageal strictures after ESD, with a particular focus on anti-inflammatory and tissue engineering approaches. The local injection of triamcinolone acetonide and other systemic steroid therapies are frequently used to prevent esophageal strictures after ESD. Tissue engineering approaches for preventing esophageal strictures have recently been applied in basic research studies. Scaffolds with temporary stents have been applied in five cases, and this technique has been shown to be safe and is anticipated to prevent esophageal strictures. Fabricated autologous oral mucosal epithelial cell sheets to cover the defective mucosa similarly to how commercially available skin products fabricated from epidermal cells are used for skin defects or in cases of intractable ulcers. Fabricated autologous oral-mucosal-epithelial cell sheets have already been shown to be safe.     

A case of esophageal intramural pseudodiverticulosis

Esophageal intramural pseudodiverticulosis (EIP) is a rare benign disease that is characterized by multiple tiny flask-shaped outpouching lesions of the esophageal wall. The etiology is unknown, but the pathologic findings include dilatation of excretory ducts of submucosal glands. The predominant symptom is dysphagia, and esophageal stricture occurs frequently. Diseases such as diabetes mellitus, esophageal candidiasis, gastroesophageal reflux disease, and chronic alcoholism are often combined. Since most EIP cases are benign, the mainstream treatment is symptom relief by endoscopic dilatation or medical treatment of accompanied diseases. This report describes the case of a 68-year-old male patient who suffered from chest tightness for 2 months and was diagnosed with EIP. This symptom disappeared after 2 months of medical treatment, and the patient is now being regularly followed up.     

Self-bougienage: long-term relief of corrosive esophageal strictures.

BACKGROUND: Corrosive esophageal strictures require dilatation at frequent intervals. OBJECTIVE: To determine the efficacy of self-dilatation in treatment of corrosive esophageal strictures. METHODS: Retrospective analysis of data from 51 patients with corrosive esophageal strictures seen in a surgical unit. Eighteen patients underwent per-oral antegrade dilatation of stricture using gum elastic bougies (Group I); 15 patients underwent retrograde dilatation with endless string using an India rubber dilator devised at the authors' institution, followed by per-oral antegrade dilatation (Group II); 15 patients underwent retrograde dilatation followed by antegrade dilatation with endless string through esophagostomy (Group III). In three patients with stricture of the entire esophagus, endless string could not be passed; they were subjected to esophagocoloplasty. All patients were taught self-dilatation with gum elastic bougies as the final step, and were put on a progressive, domiciliary, self-dilatation program. Quarterly follow up was done for one year, to ascertain whether self-bougienage was being performed properly. RESULTS: All patients responded well to treatment, with significant relief of dysphagia and improvement in health and barium study findings. Six patients developed mediastinitis (3, 2 and 1 in Groups I, II and III, respectively) during initial dilatation; all improved with conservative management. Only one patient who failed to carry out self-bougienage had to be readmitted and retrained in the procedure, after which he remained asymptomatic. CONCLUSIONS: Patients with corrosive esophageal strictures can be treated with a long-term self-bougienage program, which avoids the need for frequent hospital admissions for esophageal dilatation.     

Severe long esophageal stricture following hyperemesis gravidarum

We report a 32-year-old female patient with esophageal stricture thought to have been caused by hyperemesis gravidarum. Eleven months before admission she had been admitted to another hospital, because of hyperemesis gravidarum, at 26 weeks of gestation. Marked and recurrent vomiting occurred and her consciousness gradually worsened. Three weeks later, her baby was delivered by Cesarean section. Postpartum progress was uneventful except that she developed dysphagia 5 months after delivery. Esophagography and upper endoscopy demonstrated severe esophageal stricture. Endoscopic balloon dilatation was performed four times, but was unsuccessful. Blunt dissection of the esophagus was then performed. Histological examination demonstrated marked fibrosis in the submucosal layer and muscular hypertrophy. Esophageal glands were not identified. In this case, esophageal stricture might have been associated with severe esophagitis due to recurrent vomiting and reflux of gastric contents during hyperemesis gravidarum.     

A randomized prospective study comparing rigid to balloon dilators for benign esophageal strictures and rings.

BACKGROUND: The optimum choice of dilator (rigid vs. balloon) for benign esophageal strictures has not been well studied. The aim of this study was to compare the immediate relief of dysphagia and the incidence of repeat dilatation within the first year with the use of either a rigid (Savary) dilator or balloon dilator for benign lower esophageal strictures. METHODS: Patients with dysphagia found to have benign esophageal strictures during endoscopy were randomized to undergo dilation with a rigid (Savary) or a balloon dilator (Microvasive or Bard). The 1-year incidence of repeat dilatation was estimated by the Kaplan-Meier method. RESULTS: A total of 251 subjects were stratified at entry according to the type of stricture (peptic vs. Schatzki ring) and severity of stricture (mild vs. moderate/severe) and then randomized to either a Savary (n = 88), Microvasive (n = 81), or Bard (n = 82) dilator. There were no significant differences between the rigid dilator or the two balloons with regard to immediate relief of dysphagia or the need for repeat dilatation at one year. Patients with moderate/severe strictures required repeat dilatation at one year twice as often as those with mild strictures. There were no significant complications reported in these patients. CONCLUSIONS: Both rigid and balloon dilators are equally effective and safe in the treatment of benign lower esophageal strictures caused by acid reflux and Schatzki rings.     

Severe benign esophageal stricture following postoperative emesis

An 80-year-old man presented with dysphagia after surgery for a hepatic tumor. In the postoperative period, he suffered from emesis and thereafter experienced dysphagia when taking a solid meal. The cause of his dysphagia was a benign lower esophageal stricture that had not been detected during preoperative examinations. Conservative treatment involving balloon dilatation was not effective, and the patient finally underwent a lower esophagectomy with reconstruction of the jejunum interposition from a left thoraco-abdominal approach. Based on his clinical manifestations, pathological findings, and published reports, we suggested that he suffered an incomplete esophageal perforation after emesis that led to esophageal stricture as a result of fibrosis of the esophageal wall. This rare case demonstrates that an esophageal injury caused by postoperative emesis can result in a benign esophageal stricture.     

Aluminum phosphide-induced esophageal strictures: a new cause of benign esophageal strictures

Fifteen consecutive patients presenting with dysphagia due to aluminum phosphide (AP)-induced esophageal strictures were studied retrospectively to elucidate the natural history of AP-induced esophageal strictures and to evaluate the efficacy of bougie dilation. The median time lag between consumption of AP and occurrence of dysphagia was 3 weeks. All patients had a single stricture and could be dilated using a bougie dilator. Thirteen patients were relieved of dysphagia on a mean (SD) follow-up of 18 (7.3) months. Two patients had recalcitrant strictures and needed needle-knife incision of the stricture followed by balloon dilation. The strictures opened up well in both the patients and they were relieved of dysphagia. AP-induced esophageal stricture is a new cause of benign esophageal stricture. Most patients present with dysphagia around 3 weeks after consumption of AP tablets. A single esophageal stricture is found in these patients. Most strictures respond very well to bougie dilation. However, some of the strictures may be recalcitrant and may require needle-knife incision and balloon dilation.     

Topical mitomycin C can effectively alleviate dysphagia in children with long‐segment caustic esophageal strictures

Caustic ingestion in children and the resulting long esophageal strictures are usually difficult to be managed, and eventually, esophageal replacement was required for cases refractory to frequent dilatation sessions. Topical mitomycin C (MMC) application has been used recently to improve the results of endoscopic dilatation for short esophageal strictures. The study aims to assess the role of MMC application in management of long‐segment caustic esophageal strictures. From January 2009 to June December 2013, patients presented with long caustic esophageal stricture (>3 cm in length) were included in this study and subjected to topical MMC application after endoscopic esophageal dilatation on multiple sessions. Regular follow‐up and re‐evaluation were done. A dysphagia score was used for close follow‐up clinically; verification was done radiologically and endoscopically. During the specified follow‐up period, 21 patients with long caustic esophageal stricture were subjected to topical MMC application sessions. Clinical, radiological, and endoscopic resolution of strictures occurred in 18 patients (85.7% cure rate). Number of dilatation sessions to achieve resolution of dysphagia was (n = 14.3 ± 5.7) with application of mitomycin two to six times. There was no recurrence in short‐ and mid‐term follow‐up. No complications were encountered related to topical MMC application. MMC is a promising agent in management of long‐segment caustic esophageal strictures. Long‐term follow‐up is needed to prove its efficacy and to evaluate potential long‐term side‐effects of MMC application.