氩离子凝固术加抑酸逆转Barrett's食管上皮的临床研究

目的观察氩离子凝固术(APC)加抑酸治疗对Barrett’s食管上皮的逆转作用。方法对45例以内镜和病理确诊的Barrett’s食管病人,随机分为治疗组与对照组,治疗组采用氩离子凝固加质子泵抑制剂(APC)组,对照组采用传统质子泵抑制剂治疗(PPI组)。于治疗后第3个月和第6个月进行内镜及病理复查,观察2组Barrett’s食管上皮逆转情况。结果APC组23例Barrett’s食管上皮逆转总有效率在第3、6个月时分别为69.6%和82.6%,而对照组(PPI组)分别为9.5%和22.2%。无出血、穿孔等严重并发症。结论氩离子凝固术结合抑酸治疗能有效逆转Barrett’s食管上皮,大多数患者出现鳞状上皮再生,但不排除在新生的鳞状上皮下有残留的肠上皮化生及复发的可能,需长期随诊。

Clinical Study on Reversal of Barrett's Esophagus with Argon Plasma Coagulation and Acid Suppression

Objective To assess whether restoration of squamous epithelium can be obtained after ablation of Barrett's esophagus using argon plasma coagulation(APC)associated with proton pump inhibitor(PPI)therapy.Methods Single-blind,PPI controlled randomized study was made in patients with Barrett's esophagus,23 patients were treated with APC and esomeprazole(40 mg/d)(APC group).22 patients were accomplished with esomeprazole(40 mg/d)(PPI group).The resultes were observed by endoscopy and pathology after 3 and 6 months treatment.Results After 3 and 6 months' treatment,re-epithelialisation was visualized under endoscopy in 15/23 and 19/23 patients in APC group.At histological assessment,eradication of Barrett's esophagus were confirmed in 11/23 and 15/23 patients,and in 5/23 and 4/23 patients the new squamous epithelium covered areas of underlying intestinal metaplasia.The total effective rates of reversal of Barrett's esophagus were 69.6% and 82.6% respectively after 3 and 6 months treatment.In PPI group,endoscpy showed that 4/22 patients had complete squamous re-epithelialization after 6 months treatment.The total effective rate was 22.2% after 6 months treatment.There were no seriuos complications.Conclusion APC combined with 40 mg esomeprazole daily can eradicate Barrett's mucosa with apparent squamous re-epithelialization in majority of patients.It is both efficacious and safe in the treatment of Barrett's esophagus.However,the reappearance of squamous epithelium after therapy does not exclude the presence of underlying intestinal metaplasia.