加味旋代颗粒联合NBI内镜下APC治疗Barrett食管的临床研究

发布时间：2018-10-14 14:02

【摘要】：目的:以基于窄带成像内镜(Narrow-band imaging,NBI)技术,通过观察Barrett食管上皮的异常结构,精准进行氩离子凝固术(Argon Plasma Coagulation,APC)治疗,术后联合口服加味旋代颗粒,研究治疗前后食管上皮情况,为中西医结合治疗BE提供一种新技术和方法。方法:搜集2014年12月-2015年12月期间在广西中医药大学第一附属医院就诊符合纳入和诊断标准的BE患者,共60例,随机分为两组,治疗组(NBI内镜下APC术联合加味旋代颗粒组)和对照组(NBI内镜下APC术联合奥美拉唑组),各30例。两组患者均在NBI内镜下进行APC治疗。两组分别记录治疗前,治疗后第3、6、12个月的症状积分、胃镜普通模式改变、NBI内镜模式分型、病理组织学改变,比较两组临床治疗的疗效。结果:(1)所纳入的60例患者胃镜普通模式分型中岛型所占比例最高,NBI放大模式下食管黏膜表面结构分型中C型所占比例最高。(2)治疗组总有效率为90.00%,对照组总有效率为70.00%,临床症状积分降低更加明显。(3)内镜下观察结果与两组患者的症状改善程度相符合,治疗组患者的有效率明显高于对照组。(4)两组患者的病理检查结果,依据评定标准,在术后3个月时,治疗组病理活检总有效率为96.67%,对照组为80.00%。术后6个月时治疗组总有效率为96.67%,对照组为93.33%。术后12个月,治疗组病理活检缺失数据12人,剩余18名患者中,总有效率为94.44%;对照组病理活检缺失数据为15人,剩余15名患者中,总有效率为60.00%,两组无明显差异。结论:((1)NBI内镜下APC联合加味旋代颗粒能改善BE的临床症状,降低BE的复发率。(2)NBI内镜下APC联合加味旋代颗粒对治疗BE临床疗效优于奥美拉唑,治疗方法安全便捷,性价比高,值得临床推广。
[Abstract]:Objective: to observe the abnormal structure of esophageal epithelium in Barrett by using narrow band imaging endoscopy (Narrow-band imaging,NBI), and to study the condition of esophageal epithelium before and after treatment with argon ion coagulation (Argon Plasma Coagulation,APC). To provide a new technique and method for the treatment of BE with integrated Chinese and western medicine. Methods: from December 2014 to December 2015, 60 BE patients who met the criteria of inclusion and diagnosis in the first affiliated Hospital of Guangxi University of traditional Chinese Medicine were randomly divided into two groups. There were 30 cases in the treatment group (NBI endoscopic APC combined with modified Xuande granule group) and 30 cases in the control group (NBI endoscopic APC combined with omeprazole group). The patients in both groups were treated with APC under NBI endoscopy. The symptom scores, the changes of general gastroscope model, NBI endoscopic pattern and histopathological changes were recorded before and after treatment for 6 and 12 months in the two groups, respectively. The curative effects of the two groups were compared. Results: (1) the proportion of the island type was the highest in the 60 patients with gastroscopy, and the proportion of the C type was the highest in the NBI amplification mode. (2) the total effective rate of the treatment group was 90.00g and the total effective rate of the control group was 90.00. The score of clinical symptoms decreased more obviously. (3) the results of endoscopic observation were consistent with the degree of improvement of symptoms in the two groups. The effective rate of the treatment group was significantly higher than that of the control group. (4) according to the evaluation standard, the total effective rate of pathological biopsy was 96.6767 in the treatment group and 80.00in the control group. At 6 months after operation, the total effective rate was 96.67 in the treatment group and 93.33 in the control group. Twelve months after operation, the total effective rate of the treatment group was 94.44 out of the remaining 18 patients, while that of the control group was 15, and the total effective rate of the remaining 15 patients was 60.00. there was no significant difference between the two groups. Conclusion: (1) APC combined with Jiawei Xuande granule under NBI endoscopy can improve the clinical symptoms of BE and reduce the recurrence rate of BE. (2) APC combined with modified Xuan Cai granule under NBI endoscopy is superior to omeprazole in the treatment of BE. The treatment method is safe, convenient and cost-effective. It is worth popularizing in clinic.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R571

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