摘要
目的探讨内镜黏膜下剥离术（ESD）前黏膜下注射可溶性止血绫的运用价值。方法分别使用生理盐水溶解的液态可溶性止血绫（可溶性止血绫组）、甘油果糖（甘油果糖组）、生理盐水（生理盐水组）给12只新西兰大白兔进行胃黏膜下注射，测量并分析注射部位黏膜隆起高度。注射部位行外科手术模拟ESD，分析术后30 min出血量。可溶性止血绫组和生理盐水组注射30 min后，取注射部位全层胃黏膜组织进行病理学研究。以15只家猪为模拟ESD临床实验研究对象，距肛门20～30 cm处选择2个部位注射液态可溶性止血绫，其中一个部位行ESD，另一个则不处理，观察吸收与降解；再选择2个部位注射生理盐水，后续处理方法同可溶性止血绫。记录手术操作时间，比较两种注射剂创面修复是否存在差异。结果黏膜下注射后0 min、10 min、20 min、30 min，可溶性止血绫组隆起高度分别为（4.3±1.4）mm、（4.1±1.9）mm、（3.8±0.7）mm、（3.3±0.9）mm，甘油果糖组为（4.3±2.2）mm、（4.1±2.0）mm、（3.6±1.4）mm、（3.2±0.8）mm，生理盐水组为（3.8±1.6）mm、（2.6±1.4）mm、（1.9±1.9）mm、（1.1±0.7）mm，可溶性止血绫组黏膜隆起高度高于生理盐水组（P〈0.05），但与甘油果糖组相比，差异无统计学意义（P〉0.05）。出血量实验中，可溶性止血绫组出血量明显少于甘油果糖组[（0.36±0.07）mL比（0.42±0.06）mL，P〈0.05]，甘油果糖组出血量明显少于生理盐水组[（0.42±0.06）mL比（0.55±0.07）mL，P〈0.05]。病理学实验中，可溶性止血绫组和生理盐水组均未出现明显组织坏死等不良并发症。模拟ESD临床实验中，可溶性止血绫组完整切除率明显高于生理盐水组[86.7%（13/15）比46.7%（7/15），P〈0.05]，ESD平均操作时间明显少于生理盐水组[（3.2±0.3）min比（3.8±0.5）min，（P〈0.05）]。黏膜下注射未行ESD的部位，均未出现感染、穿孔等实验相关不良事件。结论ESD术前黏膜下注射可溶性止血绫是一种安全有效的方法。
ObjectiveTo evaluate the application value of absorbable hemostat textile as submucosal injection of endoscopic submucosal dissection （ESD）.
MethodsTwelve New Zealand rabbits were injected with absorbable hemostat textile solution, glycerol fructose and normal saline. The uplift effect was measured after injection. Simulated ESD was performed in the rabbit stomach and bleeding amount was measured. The injection site was pathologically examined at 30 minutes after the soluble hemostat textile and normal saline were injected. Fifteen pigs were injected with absorbable hemostat textile at two locations of 20-30 cm from the anus, and injected normal saline at another two locations of 20-30 cm from the anus. One site was performed simulated ESD and the other was not. Fifteen simulated ESD were performed in the soluble hemostatic group and the normal saline group, respectively. Operation time was recorded and difference in wound healing was compared between the two groups.
ResultsIn the uplift experiment, the absorbable hemostat textile group had higher uplift height （4.3±1.4 mm, 4.1±1.9 mm, 3.8±0.7 mm, 3.3±0.9 mm, respectively） at 0 min, 10 min, 20 min, 30 min than that of the glycerol fructose group （4.3±2.2 mm, 4.1±2.0 mm, 3.6±1.4 mm, 3.2±0.8 mm, respectively, P〈0.05）, and the glycerol fructose group was higher than that of the normal saline group （3.8±1.6 mm, 2.6±1.4 mm, 1.9±1.9 mm, 1.1±0.7 mm, P〈0.05）. There was no significant difference in uplift height between the absorbable hemostat textile group and the glycerol fructose group （P〉0.05）. In the bleeding experiment, the bleeding amount of absorbable hemostat textile group was significantly less than that of the glycerol fructose group （0.36±0.07 mL VS 0.42±0.06 mL, P〈0.05）; the bleeding amount of glycerol fructose group was significantly lower than that of the normal saline group （0.42±0.06 mL VS 0.55±0.07 mL, P〈0.05）. There was no obvious tissue necrosis and other adverse complications in the absorbable hemostat textile group and the normal saline group. In simulated ESD experiment, complete resection rate of the absorbable hemostat textile group was higher than that of the normal saline group [86.7%（13/15） VS 46.7%（7/15）, P〈0.05], and mean operation time of the absorbable hemostat textile group was less than that of the normal saline group （3.2±0.3 min VS 3.8±0.5 min, P〈0.05）. No hemorrhage, perforations or other related adverse events occurred in non-ESD lesions.
Conclusion
Absorbable hemostat textile is safe and effective as submucosal injection of ESD.
作者
陈钟
马明
曾智聪
刘妍
韩忠政
张秦
王君尧
唐庆林
张华玉
张鸣青
Chen Zhong, Ma Ming, Zeng Zhicong, Liu Yah, Han Zhongzheng, Zhang Qin, Wang Junyao, Tang Qinglin, Zhang Huayu, Zhang Mingqing.(Department of Gastroenterology, the Affiliated Dongnan Hospital of Xiamen University; the 175th Hospital of PLA, Zhangzhou 363000, Chin)
出处
《中华消化内镜杂志》
CSCD
北大核心
2018年第3期190-194,共5页
Chinese Journal of Digestive Endoscopy
基金
南京军区医学科技创新重点项目（15ZD026）
南京军区医学科技创新面上项目（15M5109）
青年苗圃基金（16Y002）
多学科联合攻关项目（14YLG002）
关键词
模型
动物
内镜黏膜下剥离术
可溶性止血绫
创面修复
液体垫层
Models, animal
Endoscopic submucosal dissection
Absorbable hemostat textile
Wound repair
Submucosal fluid cushion
