食管“Z”型支架术后局部粘膜血流量及通透性变化分析  

Study on changes of mucosal blood flow and permeability after esophageal "Z" stenting

作　　者：宛新建[1] 李兆申[1] 许国铭[1] 王雯[1] 湛先保[1] 刘婧[1] 

机构地区：[1]中国人民解放军第二军医大学长海医院消化内科,上海市200433

出　　处：《世界华人消化杂志》2000年第1期10-14,共5页World Chinese Journal of Digestology

基　　金：国家自然科学基金资助;NO.39670341

摘　　要：目的研究实验犬食管支架术后2,24h局部粘膜血流量的变化,食管对PEG_(400)通透性的变化,以及食管粘膜电镜下形态的变化。方法选择成年健康犬12只,均分两组,分别置入“Z”型食管支架,采用多谱勒血流仪检测支架术后2,24h局部粘膜血流量的变化,与正常食管粘膜进行比较,支架术后2h选择第1组实验犬进行食管持续恒压PEG_(400)灌流,2h后取出置架部位的食管组织及等量正常食管组织,通过气相色谱分析法检测组织中PEC_(400)的含量,并进行比较。第2组实验犬于术后24h同样方法进行气相色谱分析。电镜分析支架术后2h及24h粘膜结构的变化。结果支架术后2,24h局部粘膜血流量较正常食管均明显减少;术后2h食管组织中PEG_(400)的含量较正常明显升高,主要表现为一些低分子量的PEG_(400)术后24h PEG_(400)的通透性进一步增强,可检测到一些高分子量的PEG_(400);电镜发现支架术后上皮细胞间桥粒明显减少、破坏,细胞间隙扩大,上皮基底膜破坏,术后24h较2h变化更为明显。结论支架置入可导致食管局部粘膜血流量明显降低,从而促进粘膜的损害;支架术后上皮细胞间连接及粘膜结构破坏明显,对PDG_(400)通透性显著升高,从而为外源性致病原的介入创造条件。这些均说明支架对粘膜具有明显的破坏作用。AIM To study the changes of mucosal blood flow and permeability after esophageal 'Z' stenting. METHODS Twelve adult healthy dogs were divided into two groups, and the esophageal stent was placed respectively. Mucosal blood flow was measured with Dopplar blood flow meter, and compared with normal esophageal mucosa. Two hours after stenting PEG400 was perfused into the esophagus continuously under constant pressure in the first group for two hours. Equal weight of stenting and adjacent normal tissue were taken out, then homogenated and centrifuged. The amount of PEG400 in the supernatant was measured by gas liquid chromatography. Twenty-four hours after stenting, the same test was carried out in the second group. The mucosal structure was observed under electromicroscope 2 and 24 hours after stenting.RESULTS The mucosal blood flow decreased evidently, and the amount of PEG400 was much higher than that of normal esophagus after stenting. Electromicroscopy revealed that the number of desmosome of epithelium decreased and was impaired greatly after stenting. The interval between epithelial cells was enlarged and basement membrane was damaged. CONCLUSION Stenting might lead to evident decrease of esophageal mucosal blood flow, then impaired the junction of epithelial cells and mucosal structure greatly, and the permeability for PEG400 elevated significantly, demonstrating that stenting may impaired the esophageal mucosa evidently.

关 键 词：食管狭窄 治疗 血液供给 支架 

分 类 号：R571[医药卫生—消化系统]