玻璃酸钠在内镜黏膜下剥离术中的应用研究

Application of sodium hyaluronate to endoscopic submucosal dissection

目的评价内镜黏膜下剥离术（ESO）中使用玻璃酸钠、生理盐水及靛胭脂混合液行黏膜下注射的疗效与安全性。方法2015年9月至2016年11月间在苏州大学附属第一医院消化内镜中心行内镜检查发现胃、食管、结肠病变的233例患者，根据随机数字表按随机对照原则分为试验组（n=173）和对照组（n=50），分别采用不同黏膜下注射液配伍：试验组为玻璃酸钠100mg＋生理盐水60mL＋O．2％靛胭脂4mL，对照组为生理盐水70mL＋O．2％靛胭脂4mL，于病灶范围标记点外用混合液进行黏膜下多点注射，直至病变有效抬举后行ESD。对比两组病灶部位及大小，操作时间，注射液用量及手术相关并发症发生率。结果试验组ESD切除标本平均直径为（1．9±1．3）cm，略小于对照组的（2．0±1．8）cm，但差异无统计学意义（P〉0．05）。试验组自病变标记至完成创面处理的平均时间为（59．5±26．7）min，显著短于对照组的（68．6±29．0）min（P〈0．05）。试验组黏膜下注射液用量（55．5±31．8）niL，明显低于对照组的（66．7±35．1）mL（P〈0．05）。术后试验组迟发性出血发生率1．16％（2／173），显著低于对照组的12．00％（6／50，P〈0．05）；试验组未出现延迟性穿孔，而对照组有3例（6．00％），穿孔发生率比较差异亦有统计学意义（P〈0．05）。结论采用玻璃酸钠、生理盐水和靛胭脂配制的混合液予黏膜下注射后行ESD疗效佳，安全性高。

Objective To evaluate effects and safety of mixed solution of sodium hyaluronate, normal saline and indicarmine during endoscopic submucosal dissection （ESD）. Methods A total of 233 patients with gastric, esophageal and colonic lesions diagnosed by endoscopy in the digestive endoscopy center of the First Affiliated Hospital of Soochow University between September 2015 and November 2016 were randomly divided into the experimental group （173 patients） and the control group （50 patients）. The experimental group was injected with sodium hyaluronate 100 mg＋normal saline 60 mL＋O. 2% indicarmine 4 mL, and the control group with normal saline 70 mL＋0. 2% indicarmine 4 mL. The solutions were used for multi-point injection in submucosa outside markers of lesions, respectively, and ESD was performed until lesions were effectively lifted up. The location and size of lesions, operation time, dose of injection and the incidence of complications were compared between the two groups. Results The diameter of resected specimen was 1.9±1.3 cm in the experimental group, slightly less than that in the control group （2. 0± 1.8 cm, P〉O. 05）. The operation time from lesion mark to the end of ESD in the experimental group was 59. 5±26. 7 min, significantly less than that in the control group （68.6±29.0 min, P〈0.05）. The dose of injection in the experimental group （55.5±31.8 mL） was obviously lower than that in the control group （66. 7±35.1 mL, P〈0. 05）. The rate of delayed bleeding in the experimental group was 1.16% （2/173）,which was significantly lower than that in the control group [ 12. 00% （6/50）, P〈 O. 05 ]. No delayed perforation occurred in the experimental group, while 3 cases （6. 00%） occurred in the control group （P〈 0. 05）. Conclusion ESD shows better effects and high safety after the submucosal injection of mixed solution of sodium hyaluronate, normal saline and indicarmine.