自体食管黏膜移植术联合支架置入术对猪食管全周内镜下黏膜剥离术后狭窄的预防效果  

Preventive effect of autologous esophageal mucosal flap tip-twisting grafting combined with covered metal stent placement on stenosis after peripheral endoscopic esophageal mucosal dissection in pigs

作　　者：王立民 王新 李建[4] 李雷 WANG Limin;WANG Xin;LI Jian;LI Lei(Medical Department(The First School of Clinical Medicine),Qingdao University,Qingdao 266021,China;不详)

机构地区：[1]青岛大学医学部第一临床医学院,山东青岛266021 [2]成武县人民医院消化内科,山东成武274200 [3]成武县人民医院普外三科,山东成武274200 [4]泰安市中医二院内四科,山东泰安271000 [5]上海百汇医院消化内科,上海201107

出　　处：《山东医药》2025年第4期68-72,共5页Shandong Medical Journal

基　　金：山东省医药卫生科技发展计划项目(202103030396)。

摘　　要：目的探讨自体食管黏膜瓣蒂扭转移植术联合覆膜金属支架置入术对猪食管全周内镜下黏膜剥离术(ESD)后狭窄的预防效果。方法选择巴马小型猪9头,随机分为ESD组、支架组、黏膜瓣+支架组,每组3头。ESD组单独行食管环周ESD;支架组先行食管环周ESD,再行覆膜金属支架置入术;黏膜瓣+支架组食管环周ESD后实施自体食管黏膜瓣蒂扭转移植联合覆膜金属支架置入术。术后3周处死小型猪,解剖获取离体食管,测量食管狭窄长度和最狭窄处直径,评估离体食管组织前后左右四壁瘢痕区域固有损伤(MP)分级;称量术前和术后3周体重,计算减重率;术前及术后7 d,采集耳缘静脉血,离心留取血清,检测血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、IL-1β、转化生长因子β1(TGF-β1)。结果食管狭窄长度黏膜瓣+支架组<支架组、ESD组(P<0.05),三组食管最狭窄处直径比较差异无统计学意义(P>0.05)。三组食管组织MP分级比较差异具有统计学意义(Z=-6.222,P<0.05),其中黏膜瓣+支架组食管组织MP分级较低。黏膜瓣+支架组减重率低于支架组、ESD组(P均<0.05),支架组与ESD组比较差异无统计学意义(P>0.05)。各组术前血清TNF-α、IL-6、IL-1β、TGF-β1水平比较差异均无统计学意义(P均>0.05);黏膜瓣+支架组术后7 d血清TNF-α、IL-6、IL-1β、TGF-β1水平均低于支架组、ESD组(P均<0.05)。结论自体食管黏膜瓣蒂扭转移植术联合覆膜金属支架置入术能够有效预防猪食管全周ESD后食管狭窄,其效果优于单独ESD或联合覆膜金属支架置入术。Objective To explore the preventive effect of autologous esophageal mucosal flap tip-twisting grafting combined with covered metal stent placement on stenosis after peripheral endoscopic esophageal mucosal dissection(ESD)in pigs.Methods Nine Bama minipigs were selected and randomly divided into the ESD group,stent group,and muco-sal flap+stent group,with three pigs in each group.The peri-esophageal ESD was performed alone in the ESD group,peri-esophageal ESD was performed in the stent group followed by laminar metal stenting in the stent group,and autologous oe-sophageal mucosal flap tip-twist transplantation combined with laminar metal stenting was performed in the mucosal flap+stent group after peri-esophageal ESD.Small pigs were executed 3 weeks after surgery,and the isolated esophagus was dissected to obtain the length of esophageal stenosis and the diameter of the narrowest part of the esophagus,and the in-trinsic damage(MP)grading of the scarred area of the isolated esophageal tissues in the anterior,posterior,left,and right walls of the esophageal tissues was evaluated.The levels of serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),IL-1β,and transforming growth factor-β1(TGF-β1)were detected.Results The esophageal stenosis length was as follows:mucosal flap+stent group<stent group and ESD group(P<0.05),and the difference in the diameter of the narrowest esophagus among the three groups was not statistically significant(P>0.05).The difference in MP grading among the three groups was statistically significant(Z=-6.222,P<0.05),with the mucosal flap+stent group having a lower MP grading.The weight loss rate in the mucosal flap+stent group was lower than those in the stent group and ESD group(both P<0.05),and the difference between the stent group and the ESD group was not statistically significant(P>0.05).There were no statistically significant differences in the preoperative serum TNF-α,IL-6,IL-1β,or TGF-β1 lev-els between groups(all P>0.05);serum TNF-α,IL-6,IL-1β,and TGF-β1 levels were lowe

关 键 词：食管狭窄 内镜下黏膜剥离术 自体食管黏膜瓣蒂扭转移植术 覆膜金属支架置入术 

分 类 号：R571.1[医药卫生—消化系统]