聚羟基乙酸膜在内镜下黏膜剥离术后创面应用的初探  

Preliminary exploration polyglycolic acid applied in the wound after endoscopic submucosal dissection

作　　者：柴宁莉[1] 冯佳[1] 令狐恩强[1] 张崎[1] 王向东[1] 王红斌[1] 朱静[1] 孟江云[1] 杜红[1] 程诗阳 

机构地区：[1]解放军总医院消化内科,北京100853

出　　处：《中华胃肠内镜电子杂志》2016年第2期54-60,共7页Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)

基　　金：中国博士后科学基金(2015M582809)

摘　　要：目的探讨经内镜下黏膜剥离术(ESD)后,创面应用聚羟基乙酸(PGA)膜的效果及在人体消化道管腔内应用的安全性。方法选取解放军总医院2016年3月至4月因上消化道早癌接受ESD治疗的26例患者为研究对象,以创面是否覆盖PGA膜随机分为覆膜组和对照组。分析两组间术后并发症的发生情况、创面愈合程度、肝肾功能及血常规的改变,对比不同的固定方式对PGA膜与创面的贴合情况。结果对照组和覆膜组术后均无并发症发生。覆膜组术后1个月创面愈合度明显优于对照组(P<0.05)。术后1周、1个月化验血常规、肝肾功能对照组及覆膜组均无异常,两组间数值变化无统计学差异(P>0.05)。覆膜组13例患者,根据ESD创面大小覆盖PGA膜,分别采用钛夹、猪源性纤维蛋白黏合剂、钛夹+猪源性纤维蛋白黏合剂进行固定;术后1周内镜检查:PGA膜在食管创面的全部脱落,而在贲门及胃的均在位,猪源性纤维蛋白黏合剂固定的PGA膜与创面贴敷完好(4/4),钛夹固定的PGA膜与创面部分不能完全贴合(3/6)。1例贲门早癌患者术中出现穿孔,使用PGA膜进行了修补,后顺利完成ESD术,术后无并发症发生,1周后复查创面完整。结论 ESD术后应用PGA膜可促进创面愈合;猪源性纤维蛋白黏合剂固定PGA膜的方式可使之更加贴合创面;PGA膜可用来修补ESD术中穿孔,但PGA膜在ESD创面的临床疗效有待进一步的研究。Objective To investigate the clinical effect and security of endoscopic submucosal dissection（ESD） wound applying polyglycolic acid （PGA） sheet. Methods The correlative data of ESD treatment for 26 patients with esophageal and gastric mucosal lesions in general Hospital of PLA were analyzed from March and April 2016. There were 2 groups whether the patients with wounds cover PGA sheet. Analysize postoperative complications, the degree of wound healing between the two groups and compare the degree of different fixed methods on PGA sheet whether fit the ESD wound. Results PGA group and control group had no postoperative complications. The postoperative wound healing degree of PGA group was better than the control group （ after 1 month,P 〈 O. 05 ）. The postoperative blood biochemical and blood routine test between the two groups no significant difference（ P 〉 0.05 ）. The PGA sheets, according to the size of the wound ESD, were respectively used titanium clipping, fibrin glue spraying, fibrin glue spraying ＋ titanium clipping fix to the wounds. It was better fitting wounds by Fibrin glue spraying than titanium clipping method. One cases of cardiac lesions were perforated during ESD operation and the flaw was repaired by PGA sheet immediately,which patient state was steady postoperative. Conclusions It can promote wound healing by PGA sheet covering the ESD wound. The fitting methods was better by fibrin glue spraying than titanium clipping. The PGA sheet can be used to repair the intraoperative perforation. The clinical efficacy of wound after ESD using PGA sheet required further research.

关 键 词：内镜下黏膜剥离术 手术后并发症 伤口愈合 聚羟基乙酸膜 

分 类 号：R735[医药卫生—肿瘤]