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目的:评估口服醋酸泼尼松和口服醋酸泼尼松联合局部注射曲安奈德预防食管早期癌及癌前病变内镜黏膜下剥离术(endoscopic submucosal dissection，ESD)术后食管狭窄的疗效和安全性。方法:回顾性分析2014年12月—2019年2月在东南大学附属中大医院就诊的52例食管早期癌或癌前病变患者的病例资料，其中对照组20例(ESD术后未采取任何预防狭窄的措施)，口服组17例，口服联合局部注射组15例。主要观察：狭窄率、难治性狭窄率、ESD术后内镜下扩张次数、ESD术后首次内镜下扩张距ESD完成的间隔时间；以及是否有手术和糖皮质激素相关不良事件，是否有内镜下扩张的不良反应。结果:对照组、口服组和口服联合局部注射组ESD术后狭窄率分别为85.0%(17/20)、47.1%(8/17)和46.7%(7/15)，ESD术后难治性狭窄率分别为75.0%(15/20)、23.5%(4/17)和20.0%(3/15)，内镜下扩张次数分别为3.50(2.25，6.00)次，0.00(0.00，2.50)次和0.00(0.00，2.00)次，ESD术后首次内镜下扩张距ESD完成的间隔时间分别为(27.7±9.4)d、(110.1±46.0)d和(147.4±9.4)d，上述四个指标口服组和口服联合局部注射组均明显低于或少于对照组(n P0.05)，但ESD术后首次内镜下扩张距ESD完成的间隔时间方面差异有统计学意义(n P<0.01)。仅对照组有2例发生穿孔，其余患者均未发生ESD、糖皮质激素、内镜下扩张相关的严重不良事件。n 结论:口服泼尼松或者口服泼尼松联合局部注射曲安奈德均可有效且安全地预防食管ESD术后的狭窄，且口服联合局部注射激素可延长ESD术后首次内镜下扩张距ESD完成的间隔时间，有利于患者术后的心理恢复和生活质量的提高。“,”Objective:To evaluate the efficacy and safety of oral prednisone acetate and oral prednisone acetate combined with local injection of triamcinolone acetonide for the prevention of esophageal stricture after endoscopic submucosal dissection (ESD) for early esophageal cancer and precancerous lesions.Methods:Data of 52 patients with early esophageal cancer or precancerous lesions hospitalized from December 2014 to February 2019 in Zhongda Hospital of Southeast University were analyzed retrospectively. They were divided into the control group (group A, n n=20), oral hormone group (group B, n n=17) and oral medication combined with local injection group (group C, n n=15). The rates of stenosis and refractory stenosis, endoscopic dilatation times after ESD, time interval of first dilation after ESD and adverse events related to the operation and administration of glucocorticoids were compared among the three groups.n Results:The differences in stenosis rates [85.0% (17/20) VS 47.1% (8/17) VS 46.7% (7/15), n P<0.01], rates of refractory stenosis [75.0% (15/20) VS 23.5% (4/17) VS 20.0% (3/15),n P<0.01], and endoscopic dilatation times [3.50 (2.25, 6.00) VS 0.00 (0.00, 2.50) VS 0.00 (0.00, 2.00),n P<0.01] were statistically significant among the three groups. In pairwise comparison, the above indicators in group B and group C were significantly lower or less than those in group A (n P0.05). The time intervals of the first dilation after ESD were significantly different among the three groups (27.7±9.4 d VS 110.1±46.0 d VS 147.4±9.4 d,n P<0.01). In pairwise comparison, the first dilation intervals in group B and group C were longer than that in group A (n P<0.01), and this indicator in group C was longer than that in group B (n P<0.01). Two patients in the control group developed perforation after ESD but they were treated actively and recovered finally. No severe ESD, steroid, or perforation related adverse events occurred in any other patient of the three groups.n Conclusion:Both oral prednisone and oral prednisone combined with local injection of triamcinolone acetonide after ESD can effectively and safely prevent esophageal stricture after ESD. Oral administration combined with local injection of corticosteroids can prolong the time interval of the first dilation after ESD, which is beneficial to the psychological recovery and the improvement of patients’ life quality after the operation.