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中华胃肠内镜电子杂志 ›› 2020, Vol. 07 ›› Issue (04) : 165 -175. doi: 10.3877/cma.j.issn.2095-7157.2020.04.001

所属专题: 文献 指南共识

共识与指南

中国食管良恶性狭窄内镜下防治专家共识意见(2020,北京)
中华医学会消化内镜学分会1, 中国医师协会内镜医师分会2, 北京医学会消化内镜学分会3   
  1. 1. 中华医学会消化内镜学分会
    2. 中国医师协会内镜医师分会
    3. 北京医学会消化内镜学分会
    4. 100853 北京,解放军总医院第一医学中心消化内科
    5. 200433 上海,海军军医大学长海医院消化内科
  • 收稿日期:2020-09-28 出版日期:2020-11-15
  • 基金资助:
    首都临床特色应用研究(Z181100001718177)

Consensus of Chinese experts on the endoscopic prevention and treatment of esophageal benign and malignant stricture

Chinese Society of Digestive Endoscopy1, Chinese Digestive Endoscopy Association2, Beijing Digestive Endoscopy Society3   

  • Received:2020-09-28 Published:2020-11-15
引用本文:

中华医学会消化内镜学分会, 中国医师协会内镜医师分会, 北京医学会消化内镜学分会. 中国食管良恶性狭窄内镜下防治专家共识意见(2020,北京)[J]. 中华胃肠内镜电子杂志, 2020, 07(04): 165-175.

Chinese Society of Digestive Endoscopy, Chinese Digestive Endoscopy Association, Beijing Digestive Endoscopy Society. Consensus of Chinese experts on the endoscopic prevention and treatment of esophageal benign and malignant stricture[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2020, 07(04): 165-175.

表1 中国食管良恶性狭窄内镜下规范化防治的专家共识陈述汇总
推荐陈述
一、食管大面积病变内镜下切除术后狭窄预防
1.食管大面积病变内镜下切除术后狭窄发生率较高,需积极在术后采取相关预防措施。
2.食管黏膜病变内镜下切除的过程中,应尽量避免环周切除,尽可能保留正常黏膜。
3.对于非环周食管大面积病变内镜切除术后的患者,激素目前仍是预防术后狭窄最主要的方法。
4.对于非环周食管大面积病变内镜切除术后的患者,不建议使用金属支架进行预防狭窄。
5.对于全环周食管黏膜切除术后的患者,不建议仅单纯使用激素预防狭窄。
6.对于全环周食管黏膜切除术后的患者,可使用自体皮片移植术预防狭窄。
7.对于食管大面积病变内镜切除术后黏膜缺损长度≤10 cm的患者,可使用体外自助式扩张球囊预防狭窄。
二、食管良性狭窄的治疗
8.食管良性狭窄在治疗前要明确病因,必要时行内镜下活检以排除恶性肿瘤、明确嗜酸细胞性食管炎等特殊病因。
9.对怀疑是复杂性食管狭窄的患者,建议在术前进行食管造影检查。
10.内镜下扩张治疗是目前针对食管良性狭窄的一线治疗方法。
11.对于食管扩张术后出现发热、持续性胸痛、呼吸局促、心动过速等临床表现者,要高度怀疑食管穿孔可能。若发生穿孔,推荐立即置入全覆膜金属支架。
12.不推荐将食管支架置入作为食管良性狭窄的一线治疗方法。
三、难治性食管良性狭窄的治疗
13.内镜下扩张术或切开术联合局部注射激素可用于治疗难治性食管狭窄。
14.体外自助式扩张球囊可用于治疗难治性食管狭窄。
15.内镜下支架置入可用于治疗难治性食管狭窄。
四、食管恶性狭窄的治疗
16.对于食管恶性狭窄患者,推荐采用内镜下可膨式部分覆膜或全覆膜金属支架置入来缓解吞咽困难。
17.推荐覆膜金属支架置入作为治疗合并气管食管瘘的食管恶性狭窄患者的首选方法。
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