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异戊烷黏膜下注射应用于内镜黏膜下剥离术的实验研究 预览

Experimental evaluation of isopentane as submucosal injection agent for endoscopic submucosal dissection
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摘要 目的目前临床上黏膜下注射剂种类繁多,但使用何种黏膜下注射剂尚未达成共识。将异戊烷作为一种黏膜下注射剂,评估其可行性、有效性及安全性,为临床应用提供依据。方法 37℃恒温水浴下,对新鲜离体猪胃(离体时间〈6h)进行黏膜下注射,观察对比注射等渗盐水与注射异戊烷后黏膜隆起一定高度(1.5 cm),等渗盐水和异戊烷的用量和隆起效果;新鲜离体猪胃,用等渗盐水和异戊烷隆起相同面积(直径2 cm)的黏膜,随后采用高频电刀进行隆起部位完整切除,对比分析操作时间;在活体大鼠的胃黏膜下注射相同量(20μL)的等渗盐水(对照组)或异戊烷(实验组),测量注射部位黏膜厚度,1 h后用无菌手术刀片完整切除隆起部位(直径2mm),测定黏膜切除10min内的出血量,并对隆起部位进行病理检查。结果将离体猪胃黏膜隆起相同高度(1.5 cm),异戊烷的平均用量[(0.14±0.07)mL]显著少于等渗盐水[(13.65±4.60)]mL,差异具有统计学意义(P〈0.01)。5、10、15、20、30、45、60 min时,与等渗盐水相比,异戊烷维持率差异均有统计学差异(P〈0.01)。黏膜下等渗盐水注射初始平均隆起面积为[(18.10±6.22)cm2],60 min平均隆起面积为[(24.24±7.19)cm2],差异具有统计学意义(P=0.03);异戊烷隆起面积则相对稳定,黏膜下注射0 min和60 min时的平均隆起面积差异无统计学意义[(22.93±8.16)cm2vs(21.70±7.86)cm2,P=0.71]。异戊烷处理后平均切开时间[(3.22±0.53)min]显著短于等渗盐水处理[(9.60±1.98)min],差异具有统计学意义(P〈0.01)。黏膜下注射前后异戊烷处理后、黏膜厚度变化差值显著高于等渗盐水处理[(1.34±0.30)mm vs(0.28±0.16)mm,P=0.000]。结论黏膜下注射异戊烷可持久维持有效的黏膜隆起高度,有利于后续内镜黏膜切除操作,对组织无损害,有望成为一种新型的黏膜下注射剂。 Objective At present,there are a wide range of clinical submucosal injection agents.However,no consensus has been reached on what kind of submucosal injections to use.This study aims to evaluate the feasibility,effectiveness and safety of isopentane as a submucosal injection agent and further provide an evidence for clinical application.Methods Fresh in vitro porcine stomach(In vitro time 6 h) was used to be submucosal injected with isotonic saline(control group) and isopentane(isopentane group) in 37 ℃ water bath.We evaluated the injection volume and uplift effect of both submucosal injection agents when the uplift height was 1.5 cm; A 2 cm diameter of mucous uplift was made by isotonic saline or isopentane and then dissected by electrical knife.The operation time was evaluated; 20 μL of isotonic saline or isopentane was submucosal injected in living rat stomach.The mucosal uplift height was measured.1 hour after injection,uplift site(2 mm diameter) was completely dissected by sterile scalpel,bleeding volume was measured within 10 minutes,and the pathological examination of the uplift site was carried out.Results The same height of mucous uplift(1.5 cm) can be achieved by less isopentane [(0.14 ± 0.07) m L] compared with isotonic saline [(13.65 ± 4.60) m L],the difference is statistically significant(P 0.01).Isopentane had better uplifting persistency in 5,10,15,20,30,45,60 min(P 0.01).The initial mean uplift area in control group was [(18.10±6.22) cm2],and mean uplift area after 60 min was [(24.24±7.19)cm2],the difference is statistically significant(P= 0.03).While isopentane group had a relatively stable uplift area,the mean uplift area was comparable between control group and isopentane group at 0 and 60 min [(22.93 ± 8.16) cm2 vs(21.70 ± 7.86) cm2,P =0.71].Similarly,average dissection time was shorter in isopentane group [(3.22± 0.53) min]compared with control group [(9.60±1.98) min](P0.01).The mucosal thickness variation before a
出处 《医学研究生学报》 北大核心 2018年第3期279-283,共5页 Bulletin of Medical Postgraduate
作者简介 医学研究生硕士;通信作者:范志宁,E-mail:fanzhining@njmu.edu.cn
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