经内镜粘膜下注射自体血溶液用于EMR和ESD的临床研究

A Clinical Study of Endoscopic Submucosal Injection by Autologous Blood Solution for EMR and ESD

目的评估经内镜粘膜下注射自体血用于内镜下粘膜切除术(EMR)和内镜下粘膜剥离术(ESD)的临床价值。方法纳入74例经内镜确诊的消化道粘膜及粘膜下病变患者,分析粘膜下注射人自体全血用于EMR和人自体50%血浆用于ESD的内镜和病理特征。结果相比生理盐水,41例患者消化道粘膜下注射自体全血后EMR实验和33例患者注射自体50%血浆后ESD实验所获取的病理组织均提示组织水肿显著减轻(P<0.002),产生的有效钝性分离显著增加(P<0.001)。结论利用人自体血液作为粘膜下注射试剂,相比生理盐水,能减少注射所致粘膜组织损伤,增加粘膜层和肌层之间的有效钝性分离,这可能对减少内镜手术时间,减少术中穿孔、出血等并发症,促进术后溃疡愈合有重要作用。

Objective To evaluate the clinical value of endoscopic submucosal injection by autoi- ogous blood solution for EMR and ESD. Methods 74 cases with confirmed gastrointestinal mu- cosal and submucosal disease in the Second Affiliated Hospital of Nanjing Medical University from June to Sep in 2011 and from June to July in 2012 were included. The endoscopic and pathological features of tissue damage after submucosal injection by autologous whole blood for EMR and autologous 50% plasma for ESD were analyzed. Results 41 patients who under- went EMR and 33 patients who underwent ESD were studied with the comparison of autolo- gous blood solution and normal saline. The hydrops score in the group with normal saline was higher than that in the group with blood injection （P〈0. 002）. The tearing score in the group with normal saline was lower than that in the group with blood solution （P〈0. 001）. Conclusion Autologous blood solution,as a ＂free＂ submucosal injection material compared with normal sa- line,may play a role in reducing mucosal tissue damage and increasing blunt dissection be- tween mucosa and muscularis. The blunt dissection may promote the healing of artificial ulcer, shorten the procedure time and decrease the risk of perforation and bleeding during endoscopic submucosal therapy.