【摘要】：目的:以基于窄帶成像內(nèi)鏡(Narrow-band imaging,NBI)技術(shù),通過觀察Barrett食管上皮的異常結(jié)構(gòu),精準(zhǔn)進(jìn)行氬離子凝固術(shù)(Argon Plasma Coagulation,APC)治療,術(shù)后聯(lián)合口服加味旋代顆粒,研究治療前后食管上皮情況,為中西醫(yī)結(jié)合治療BE提供一種新技術(shù)和方法。方法:搜集2014年12月-2015年12月期間在廣西中醫(yī)藥大學(xué)第一附屬醫(yī)院就診符合納入和診斷標(biāo)準(zhǔn)的BE患者,共60例,隨機(jī)分為兩組,治療組(NBI內(nèi)鏡下APC術(shù)聯(lián)合加味旋代顆粒組)和對照組(NBI內(nèi)鏡下APC術(shù)聯(lián)合奧美拉唑組),各30例。兩組患者均在NBI內(nèi)鏡下進(jìn)行APC治療。兩組分別記錄治療前,治療后第3、6、12個(gè)月的癥狀積分、胃鏡普通模式改變、NBI內(nèi)鏡模式分型、病理組織學(xué)改變,比較兩組臨床治療的療效。結(jié)果:(1)所納入的60例患者胃鏡普通模式分型中島型所占比例最高,NBI放大模式下食管黏膜表面結(jié)構(gòu)分型中C型所占比例最高。(2)治療組總有效率為90.00%,對照組總有效率為70.00%,臨床癥狀積分降低更加明顯。(3)內(nèi)鏡下觀察結(jié)果與兩組患者的癥狀改善程度相符合,治療組患者的有效率明顯高于對照組。(4)兩組患者的病理檢查結(jié)果,依據(jù)評定標(biāo)準(zhǔn),在術(shù)后3個(gè)月時(shí),治療組病理活檢總有效率為96.67%,對照組為80.00%。術(shù)后6個(gè)月時(shí)治療組總有效率為96.67%,對照組為93.33%。術(shù)后12個(gè)月,治療組病理活檢缺失數(shù)據(jù)12人,剩余18名患者中,總有效率為94.44%;對照組病理活檢缺失數(shù)據(jù)為15人,剩余15名患者中,總有效率為60.00%,兩組無明顯差異。結(jié)論:((1)NBI內(nèi)鏡下APC聯(lián)合加味旋代顆粒能改善BE的臨床癥狀,降低BE的復(fù)發(fā)率。(2)NBI內(nèi)鏡下APC聯(lián)合加味旋代顆粒對治療BE臨床療效優(yōu)于奧美拉唑,治療方法安全便捷,性價(jià)比高,值得臨床推廣。
[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.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R571

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本文編號：2270691