上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2026, Vol. 46 ›› Issue (8): 1109-1116.doi: 10.3969/j.issn.1674-8115.2026.08.011

• 论著 · 临床研究 • 上一篇    

他汀类药物联合糖皮质激素对大面积内镜黏膜下剥离术后食管狭窄的效果分析

宋红召1, 孟霞1, 江涛2, 李彤彤1, 李喆楠1, 王军民1()   

  1. 1.河北医科大学第三医院消化内科，石家庄 050051
    2.河北省邯郸市涉县医院消化内科，邯郸 056400
  • 收稿日期:2025-12-25 接受日期:2026-02-24 出版日期:2026-08-04 发布日期:2026-08-04
  • 通讯作者: 王军民，主任医师，博士；电子信箱：teacher2021@hebmu.edu.cn。
  • 作者简介:第一联系人：宋红召撰写论文初稿，孟霞负责数据统计分析，江涛、李彤彤负责数据收集、整理，李喆楠参与论文修改，王军民负责论文修改及最终审核。所有作者均阅读并同意最终稿件的提交。
  • 基金资助:
    河北省卫生健康委员会科研基金(20201040)

Analysis of the effect of statins combined with glucocorticoids on esophageal stricture after large-area endoscopic submucosal dissection

Song Hongzhao1, Meng Xia1, Jiang Tao2, Li Tongtong1, Li Zhenan1, Wang Junmin1()   

  1. 1.Department of Gastroenterology, Hebei Medical University Third Hospital, Shijiazhuang 050051, China
    2.Department of Gastroenterology, Shexian Hospital, Handan, Hebei Province, Handan 056400, China
  • Received:2025-12-25 Accepted:2026-02-24 Online:2026-08-04 Published:2026-08-04
  • Contact: Wang Junmin, E-mail: teacher2021@hebmu.edu.cn.
  • About author:First author contact:Song Hongzhao drafted the initial version of the manuscript. Meng Xia conducted the data analysis. Jiang Tao and Li Tongtong were responsible for data collection and organization. Li Zhenan participated in manuscript revision. Wang Junmin was responsible for revising the manuscript and conducting the final review. All authors have read the final version of the manuscript and consented to its submission.
  • Supported by:
    Scientific Research Fund of the Health Commission of Hebei Province(20201040)

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摘要：

目的·评估他汀类药物联合糖皮质激素对大面积内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）后食管狭窄的预防效果。方法·采用回顾性队列研究，纳入2015年1月至2023年1月河北医科大学第三医院消化内科因早期食管癌或食管癌前病变行ESD且手术创面≥环周3/4的患者。收集患者基线资料、手术相关资料及术后随访资料等。所有患者术后均口服醋酸泼尼松。按照是否联合服用他汀类药物将患者分为口服激素组和口服激素+他汀组。比较2组患者术后食管狭窄发生率、首次狭窄发生时间、狭窄后内镜下球囊扩张次数以及不良反应发生情况。采用Logistic回归进一步探究食管狭窄的危险因素。结果·共纳入53例患者，其中口服激素组32例、口服激素+他汀组21例。2组患者在冠状动脉粥样硬化性心脏病、脑梗死和高脂血症患病方面的差异具有统计学意义（均P<0.05），在性别、年龄、体质量指数（body mass index，BMI）、吸烟史、饮酒史、是否合并高血压或糖尿病，以及食管病变部位、病变浸润深度、术后病理结果、切除黏膜纵向长度等方面差异无统计学意义。53例患者中有16例出现食管狭窄，总狭窄率为30.2%；其中，口服激素组狭窄率高于口服激素+他汀组（37.5% vs 19.0%），但差异无统计学意义（P=0.152）。食管狭窄后，口服激素+他汀组较单纯口服激素组患者应用球囊扩张次数少［（1.50±0.58）次vs（2.33±0.65）次］，差异有统计学意义（P=0.040）。2组患者首次狭窄发生时间差异无统计学意义（P=0.368）。多因素Logistic回归分析显示，环周创面是食管狭窄的危险因素（OR=35.266，95% CI 5.600~222.103，P<0.001），而应用他汀类药物与食管狭窄的关系无统计学意义（OR=0.216，95% CI 0.033~1.393，P=0.107）。结论·糖皮质激素联合他汀类药物可安全、有效地减少食管ESD术后狭窄患者的球囊扩张次数，减轻食管狭窄的严重程度。

关键词: 食管狭窄, 他汀类药物, 糖皮质激素, 内镜黏膜下剥离术, 食管肿瘤

Abstract:

Objective ·To evaluate the efficacy of statins combined with glucocorticoids in preventing esophageal stricture after large-area endoscopic submucosal dissection (ESD). Methods ·This was a retrospective cohort study. Patients who underwent ESD for early-stage esophageal carcinoma and precancerous lesions with a surgical wound covering ≥3/4 of the circumference in the Department of Gastroenterology, Hebei Medical University Third Hospital, from January 2015 to January 2023 were enrolled. Patient baseline data, surgery-related information, and postoperative follow-up data were collected. All patients received oral prednisone acetate postoperatively. Patients were categorized into two groups based on statin administration: an oral glucocorticoid group and an oral glucocorticoid plus statin group. The two groups were compared in terms of the incidence of postoperative esophageal stricture, time to first stricture onset, number of balloon dilations after stricture formation, and adverse reactions. Multivariate Logistic regression analysis was employed to identify risk factors associated with esophageal stricture. Results ·A total of 53 patients were enrolled, including 32 in the oral glucocorticoid group and 21 in the oral glucocorticoid plus statin group. There were significant differences in the prevalence of coronary heart disease, cerebral infarction, and hyperlipidemia between the two groups (all P<0.05). However, no significant differences were observed in gender, age, body mass index (BMI), smoking history, drinking history, history of hypertension or diabetes, esophageal lesion location, lesion invasion depth, postoperative pathological results, and longitudinal length of resected mucosa. A total of 16 patients developed postoperative esophageal stricture in the 53 patients, with an overall stenosis rate of 30.2%. The oral glucocorticoid group exhibited a higher stricture rate compared with the oral glucocorticoid plus statin group (37.5% vs 19.0%), though this difference was not statistically significant (P=0.152). After esophageal stricture occurred, the number of balloon dilations was significantly lower in the oral glucocorticoid plus statin group than in the oral glucocorticoid group [(1.50±0.58) times vs (2.33±0.65) times, P=0.040]. There were no significant differences in the time to first stricture onset between the two groups (P=0.368). Multivariate Logistic regression analysis identified circumferential wound involvement as a significant risk factor for esophageal stricture (OR=35.266, 95% CI 5.600‒222.103, P<0.001). However, the use of statins showed no statistically significant association with esophageal stricture (OR=0.216, 95% CI 0.033‒1.393, P=0.107). Conclusion ·The combination of glucocorticoids and statins can safely and effectively reduce the number of balloon dilatations and alleviate the severity of esophageal stricture in patients developing esophageal stricture after ESD.

Key words: esophageal stricture, statin, glucocorticoid, endoscopic submucosal dissection (ESD), esophageal neoplasm

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