氩离子凝固术治疗食管病变的安全性研究  

Safety on argon plasma coagulation in treatment of esophageal lesions

作　　者：康秀峰[1] 刘培君[2] 袁月[1] 王志中[1] 代剑华[1] 彭贵勇[1] 

机构地区：[1]第三军医大学西南医院全军消化病研究所,重庆400038 [2]天水市第一人民医院心内科,甘肃天水741000

出　　处：《第三军医大学学报》2013年第10期1009-1013,共5页Journal of Third Military Medical University

基　　金：国家自然科学基金(81070384)~~

摘　　要：目的研究氩离子凝固器不同输出参数对活体犬食管损伤的影响,探讨氩离子凝固术(argon plasma coagu-lation,APC)治疗食管疾病的安全范围。方法①采用氩离子凝固器,通过选择不同的输出功率(50、60、70、80 W)、氩气流量(1.6、2.0、2.4 L/min)及作用时间(2、4 s),对3只活体犬食管黏膜进行凝固,切片HE染色,光学显微镜下观察组织损伤深度。②固定氩气流量(2.0 L/min)与作用时间(3 s),选择不同输出功率(50、60、70、80、90、100 W),对2只活体犬食管黏膜切片进行HE染色,光学显微镜下观察组织损伤深度。③将8只活体犬分为2组,采用60 W(2 L、3 s)与70 W(2 L、3 s)输出参数对2组犬食管黏膜(距门齿40 cm处)进行环形烧灼,第2、4周时用胃镜与超声胃镜观察黏膜瘢痕增生及食管狭窄情况。结果①APC输出功率、氩气流量及持续作用时间与食管组织损伤深度之间均存在正相关关系,其中功率变化对损伤深度的影响最大;②氩气流量及作用时间固定的条件下,功率增加,食管组织损伤深度相应增加,在70～90 W内,功率变化而组织损伤变化不显著;③APC输出参数为60、70 W(2 L、3 s)作用于犬食管黏膜,第2、4周时观察,70 W(2 L、3 s)作用后均显示食管损伤部位瘢痕增生,管腔狭窄而60 W(2 L、3 s)作用后瘢痕增生,管腔狭窄均不明显。结论通过选择合适的APC输出参数,可控制食管损伤程度,当输出功率≤60 W时可有效预防APC术后食管狭窄等并发症的发生。Objective To explore the effect of different output parameters of argon plasma coagulation （APC） equipment on esophageal injury in dogs, and to investigate the safe range of APC treatment for esophageal diseases. Methods （1） Esophageal mucosa of three dogs was solidified with APC using different output power （50, 60, 70 and 80 W）, argon flow （1.6, 2.0 and 2.4 L/min） and acting time （2 and 4 s）. After slicing and HE staining, the depth of tissue damage was observed with an optical microscope. （2） Esophageal mucosa of two dogs was solidified with APC using argon flow of 2.0 L/min, acting time of 3 s and different output power （50, 60, 70, 80, 90 and 100 W）. After slicing and HE staining, the depth of tissue damage was observed with an optical microscope. （3） Eight dogs were randomly divided into two groups. The esophageal mucosa at forty centimeters away from the incisor was annularly burned with APC using output power of 60 and 70 W. The mucosal scar formation and esophageal stenosis was observed by gastroscopy and ultrasound gastroscopy after 2 and 4 weeks. Results The depth of esophageal tissue damage was positively correlated with the APC output power, argon flow and acting time. The output power had the greatest effect on the depth of damage. In condition of fixed argon flow and acting time, pathological score of esophageal tissue damage increased with the rise of power. Within the range of 70 to 90 W, the variation of tissue injury was not significant. After 2 and 4 weeks, the scar formation and esophageal stenosis in esophageal injury site was observed with the APC output parameter of 70 W （2 L, 3 s）. However, the scar formation and esophageal stenosis was not obvious with the APC output parameter of 60 W （2 L, 3 s）. Conclusion By selecting the appropriate APC output parameters, we could control the degree of esophageal injury. The output power of 60 W or less can effectively prevent the occurrence of complications such as APC postoperative esophageal st

关 键 词：氩离子凝固术 食管损伤 并发症预防 

分 类 号：R571.05[医药卫生—消化系统] R616[医药卫生—内科学]