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目的以生理盐水(NS)为对照,评估不同浓度的海藻酸钠(SA)溶液作为黏膜下注射液,用于内镜黏膜下剥离术(ESD)的可行性及优越性。方法 1在新鲜离体猪食管及猪胃的黏膜下,注入不同浓度的SA溶液及NS溶液,观察并测量各注射液所致黏膜隆起高度,及此高度随时间的变化情况;2在活体小猪的胃黏膜下注射SA溶液后,模拟进行ESD手术,观察SA溶液对ESD术的辅助作用。结果离体猪食管、胃实验中,注射相同体积SA溶液的实验组所致黏膜隆起高度明显高于注射NS的对照组。其中,食管黏膜下注射1%SA溶液与注射NS相比,差异有统计学意义(P<0.01);胃黏膜下注射3%SA溶液维持黏膜隆起高度与注射NS相比,差异有统计学意义(P<0.001)。活体小猪胃模拟ESD术的实验中,注射SA溶液可以明显地分离组织、隆起黏膜,且形成稳定的凝胶垫,促进术中快速剥离黏膜的同时保护下层组织。结论黏膜下注射SA溶液可以持久地维持黏膜隆起高度,有利于黏膜组织的剥离切除,且由于其黏性,可较好地在黏膜下形成保护屏障,并对创面起到一定的压迫止血作用,可减少ESD术中穿孔、出血等并发症的出现。因此,SA是可用于临床的较为理想的黏膜下注射液。
Objective To evaluate the feasibility and superiority of different concentrations of sodium alginate (SA) solution as submucosal injection for the treatment of endoscopic submucosal dissection (ESD) with saline as control. Method 1 In fresh pig esophagus and pig stomach under the submucosal injection of different concentrations of SA solution and NS solution, observe and measure the mucosal uplift caused by the injection height, and the height with time changes; 2 in vivo small Pigs were injected subcutaneously with SA solution into pigs to simulate ESD operation and to observe the auxiliary effect of SA solution on ESD. Results In ex vivo pig esophageal and gastric experiments, the height of mucosal uplift induced by the experimental group injected with the same volume of SA solution was significantly higher than that of the control group injected with NS. Among them, 1% SA solution in esophageal submucosal injection compared with NS injection, the difference was statistically significant (P <0.01); gastric submucosal injection of 3% SA solution to maintain the height of mucosa compared with NS injection, the difference was statistically significant (P <0.001). In live piglet gastric simulated ESD operation, injection of SA solution can obviously separate the tissue, uplift the mucosa, and form a stable gel pad, which can promote rapid dissection of the mucosa during operation and protect the underlying tissue. Conclusion Submucosal injection of SA solution can maintain the height of mucosal membrane for a long time, which is good for the dissection and excision of mucosal tissue. Because of its viscosity, it can form a protective barrier under the submucosa and exert some hemostasis on the wound surface. Can reduce the occurrence of perforation, bleeding and other complications in ESD. Therefore, SA is the ideal submucosal injection for clinical use.