不同浓度亚甲蓝染色对结直肠病变EMR及ESD的影响  

Different concentrations of methylene blue staining of EMR and ESD in the colorectal operation

作　　者：李会霞[1] 王再见[1] 江海燕[1] 梁洁[1] 候朝英 

机构地区：[1]北京中医药大学第三附属医院内镜中心,100029

出　　处：《中华腔镜外科杂志（电子版）》2015年第3期34-37,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的评价不同浓度亚甲蓝对内镜黏膜下剥离术(ESD)及内镜黏膜切除术(EMR)治疗结直肠病变的影响。方法选取2012年3月至2014年10月结直肠病变住院患者96例,按入院时间顺序平均分为4组,每组24例。A组,用100 ml甘油果糖肾上腺素混合液作为黏膜下注射液;B组、C组、D组分别在A组的基础上加用1%亚甲蓝2、4、8 mg。记录各组EMR及ESD生命体征、术中及术后并发症、黏膜下注射液用量、手术时间等,行组间或组内对比分析。结果各组均完成手术,组间术前与术中生命体征比较,差异均无统计学意义(P>0.05);其中1例术中发现穿孔,1例术后发现穿孔,均给予钛夹夹闭;1例术中出血,局部电凝、钛夹夹闭后血止。术中出血发生率,各组间比较,差异均无统计学意义(P>0.05)。穿孔率仅见于A组及D组ESD中。黏膜下注射液用量:EMR组中,C组[(18.3±14.2)ml]明显低于其他组[A组(28.1±10.8)ml、B组(25.4±11.5)ml、D组(40.1±18.4)ml],差异均有统计学意义(P<0.05);A组、B组、D组间比较,差异均无统计学意义(P>0.05);ESD组中,C组[(28.1±13.5)ml]明显低于其他组[A组(45.6±19.9)ml、B组(36.1±9.6)ml、D组(42.2±15.3)ml],差异均有统计学意义(P<0.05);A组、B组、D组间比较,差异均无统计学意义(P>0.05)。手术时间:EMR组中各组间比较,差异均无统计学意义(P>0.05);ESD组中,C组[(52.2±27.0)min]明显少于其他组[A组(72.1±44.7)min、B组(69.3±14.1)min、D组(80.0±43.8)min],差异均有统计学意义(P<0.05);A组、B组、D组间比较,差异均无统计学意义(P>0.05)。结论 EMR及ESD中使用100 ml甘油果糖加肾上腺素及1%亚甲蓝4 mg混合液作为黏膜下注射效果最佳,可以显著降低手术时间,并减少注射液用量。Objective Evaluation of the influence of different concentration of methylene blue on endoscopic submucosal dissection（ ESD） and endoscopic mucosal resection（ EMR） in the treatment of colorectal lesions. Method From Mar. 2012 to Oct. 2014,96 cases of hospitalized patients with colorectal diseases were divided into 4 groups according to the order of admission time. Each group consists of24 cases. Group A only use 100 ml glycerol fructose mixture as submucosal injection adrenaline,group B,C and D groups respectively on the basis of group A with 1% concentration of methylene blue 2,4,8 mg.Record groups of EMR and ESD vital signs,intraoperative and postoperative complications,submucosal injection dosage,operation time etc,analysis of the contrast in parallel or group. Results Four groups were successfully completed surgery,between groups,preoperative and intraoperative vital signs such as heart rate,blood pressure,breathing compares differences had no statistical significance（ P 0. 05）,including 1case of perforation,1 case was found Delayed perforation,all give titanium clip clip,1 case of acute massive hemorrhage,local electric coagulation and blood check after the titanium clip clip. The incidence of intraoperative bleeding,comparing differences between groups were no statistical significance（ P 0. 05）.Perforation only appear in group A and group D with ESD operation. Submucosal injection dosage,EMR：group C（ 18. 3 ± 14. 2） ml,significantly lower than the other group A（ 28. 1 ± 10. 8） ml,group B（ 25. 4 ±11. 5） ml and group D（ 40. 1 ± 18. 4） ml,differences were statistically significant（ P 0. 05）,and the difference between group A and group B and D group had no statistical significance（ P 0. 05）; ESD： group C（ 28. 1 ± 13. 5） ml,significantly lower than group A（ 45. 6 ± 19. 9） ml 、group B（ 36. 1 ± 9. 6） ml and group D（ 42. 2 ± 15. 3） ml,differences were statistically significant（ P 0. 05）,and the difference between group A and group B and D grou

关 键 词：亚甲蓝 ESD EMR 

分 类 号：R574[医药卫生—消化系统]