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海藻酸钠作为用于内镜黏膜下切除术的一种理想的黏膜下注射材料:初步实验及临床研究

发布日期:2014-1-29 12:40:22 文章来源:GIE 作者次数:1138
    海藻酸钠作为用于内镜黏膜下切除术的一种理想的黏膜下注射材料:初步实验及临床研究
     
    背景
    海藻酸钠在临床上常用于治疗消化性溃疡病。其粘度使它很可能成为一种新的用于内镜下切除术的粘膜下注射材料。
     
    目的
    评估使用海藻酸钠行内镜黏膜下剥离术的可行性。
     
    环境和干预
    在猪胃部测定海藻酸钠病变组织提起性能,并与生理盐水溶液和透明质酸钠溶液相比较。 确认适当浓度的海藻酸钠后,使用海藻酸钠对11例胃粘膜癌或腺瘤患者行内镜黏膜下剥离术。
     
    主要测量指标
    评估海藻酸钠病变性质和临床疗效。
     
    结果
    在猪胃部注入3%海藻酸钠后,其粘膜下提起厚度与使用透明质酸钠提起厚度相当。使用海藻酸钠对所有患者成功行内镜黏膜下剥离术而且无不良反应,仅1例大约30分后胃壁短暂收缩而后自发消失。肿瘤平均直径为15.3毫米。对所有患者都取得整块切除和阴性切缘。 组织病理学检查显示所有肿瘤局限于粘膜层,除1例仅限于粘膜下层且无淋巴管浸润,手术中未发生不良反应如组织损伤等。也没有患者需要额外治疗。在28个月内的中途随访中没有1例患者复发。
     
    局限性
    样本直径小。
     
    结论
    此初步研究表明,海藻酸钠很可能成为一种新型安全的用于内镜切除术的粘膜下注射材料。 关于海藻酸钠性能的进一步调查将继续进行。
     
    缩写词:ESD, 内镜黏膜下剥离
     
     
     
     
    Sodium alginate as an ideal submucosal injection material for endoscopic submucosal resection: preliminary experimental and clinical study
    Background
    Sodium alginate is used clinically in the treatment of peptic ulcer disease. Because of its viscosity, sodium alginate could possibly become a new submucosal injection material for use in endoscopic resection.
    Objective
    We evaluated the feasibility of endoscopic submucosal dissection (ESD) using sodium alginate.
    Setting and Interventions
    The lesion-lifting properties of sodium alginate were examined in porcine stomachs and were compared with those of normal saline solution and sodium hyaluronate solution. After confirming the proper concentration of sodium alginate, ESD using sodium alginate was performed in 11 patients with gastric mucosal cancer or adenoma.
    Main Outcome Measurement
    The lesion-lifting properties of sodium alginate and clinical outcomes were assessed.
    Results
    The thickness of the submucosal elevation created by 3% sodium alginate in porcine stomach was equivalent to that of sodium hyaluronate. ESD using sodium alginate was completed successfully in all patients without adverse effects except in 1 patient in whom transient shrinkage of the gastric wall disappeared spontaneously after approximately 30 minutes. The mean tumor size was 15.3 mm. En bloc resection and a negative resection margin were obtained in all. Histopathologic examination revealed that all tumors were confined to the mucosal layer except for 1 that was confined to the submucosal layer without lymphovascular invasion, and there were no adverse effects such as tissue damage. No patient required additional treatment, and none showed recurrence during a median follow-up period of 28 months.
    Limitations
    Small sample size.
    Conclusion
    This preliminary study suggests that sodium alginate might be a novel, safe submucosal injection material for use in endoscopic resection. Further investigation of the properties of sodium alginate is warranted.
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