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一项关于内镜下黏膜剥离术并伴随二氧化碳注入治疗食管疾病后的纵膈气肿的评估性初步研究

发布日期:2014-1-29 12:40:42 文章来源:ENDOSCOPY 作者次数:1101
     一项关于内镜下黏膜剥离术并伴随二氧化碳注入治疗食管疾病后的纵膈气肿的评估性初步研究

    日本宫城县仙台市医疗中心消化科

    背景与目的:食管无浆膜,所以食管内镜黏膜下剥离(ESD)术有时可导致纵膈气肿,无穿孔。食管内镜黏膜下剥离过程中注入二氧化碳(CO2)可能会降低纵膈气肿的发病率。本研究中,患者分为两组,一组在食管ESD期间接受二氧化碳注入,另一组在食管ESD期间接受标准空气注入,故本研究目的是比较这两组患者ESD术后纵膈气肿的发病率和严重性。

    患者和方法:本研究共纳入27例于20097月至20103月接受食管ESD和二氧化碳注入患者(CO2组)。另105例患者于20043月至20095月接受食管ESD和空气注入,作为历史性对照组(空气组)。ESD术后即刻进行多螺旋CTMDCT)。第二天进行常规胸部X光摄影。经MDCTX光照片,我们对两组的纵膈气肿结果进行了比较。

    结果CO2组经胸部X光照片检测出的纵膈气肿为0%,而空气组经胸部X光照片检测出的纵膈气肿为6.6%n.s.)。经MDCT检查,CO2组出现纵膈气肿的频率低于空气组,即为30%63%P = 0.002。同时,CO2组的纵膈气肿的严重性也低于空气组。

    结论:鉴于经X光照射检测出的纵膈气肿不常见,故ESD术后立即行MDCT可发现ESD术后纵膈气肿的发生率。在食管ESD期间注入 

    CO2而不是空气可显著降低术后纵膈气肿发生。CO2可被视为食管ESD的注入气体。


    A pilot study to assess mediastinal emphysema after esophageal endoscopic submucosal dissection with carbon dioxide insufflation

    Y. Maeda, D. Hirasawa, N. Fujita, T. Obana, T. Sugawara, T. Ohira, Y. Harada, T. Yamagata, K. Suzuki, Y. Koike, Y. Yamamoto, Z. Kusaka, Y. Noda

    Department of Gastroenterology, SendaiCityMedicalCenter,Sendai,Miyagi,Japan

    Background and aims: Mediastinal emphysema sometimes develops following esophageal endoscopic submucosal dissection (ESD) without perforation because the esophagus has no serosa. Carbon dioxide (CO2) insufflation during esophageal ESD may reduce the incidence of mediastinal emphysema. The aim of the present study was to compare the incidence and severity of post-ESD mediastinal emphysema in patients receiving CO2 insufflation vs. standard air insufflation during esophageal ESD.

    Patients and methods: A total of 27 patients who had undergone esophageal ESD with insufflation of CO2 between July 2009 and March 2010 were enrolled in this study (CO2 group). Another 105 patients who had undergone esophageal ESD with air insufflation between March 2004 and May 2009 were included as historical controls (air group). Multi-detector row computed tomography (MDCT) was carried out immediately after ESD. A conventional chest radiograph was taken the next day. Mediastinal emphysema findings on MDCT and radiography were compared between the groups.

    Results: Mediastinal emphysema detected by chest radiography was 0 % in the CO2 group vs. 6.6 % in the air group (n.s.). Mediastinal emphysema on MDCT was significantly less frequent in the CO2 group compared with the air group (30 % vs. 63 %; P = 0.002). The severity of mediastinal emphysema also tended to be lower in the CO2 group.

    Conclusions: Whereas mediastinal emphysema detected by radiography is not so common, MDCT immediately after ESD revealed a certain prevalence of post-ESD mediastinal emphysema. Insufflation of CO2 rather than air during esophageal ESD significantly reduced postprocedural mediastinal emphysema. CO2 can be considered as insufflating gas for esophageal ESD.

     

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