自制新型内镜多功能圈套器在离体/活体猪胃肠道内镜电切术中的应用评估

Assessment of novel endoscopic multi-functional snare for endoscopic resection in porcine model invivoand in vitro

目的:探讨自制新型内镜多功能圈套器在动物离体及活体胃肠道内镜电切术中应用的可行性、安全性和有效性。方法:采用自制新型内镜多功能圈套器对离体猪胃、离体猪肠、体猪胃、活体猪肠直径约1cm的模拟病变进行电切,电切功率分为低、中、高3种(20 W、30 W、40 W),采用氩气烧灼创面止血。观察记录完整切除率、1周后创面愈合情况(活体实验)、有无术中及围手术期并发症。切除病变及创面送病理检测,观察有无固有肌层损伤。结果:离体猪胃手术中,9处模拟病变均完整切除;低功率(20 W)下,自制新型内镜多功能圈套器对离体猪肠病变切除效果最佳,中功率及高功率下使用后结痂较明显,影响进一步使用。离体实验中肉眼及病理观察创面均未见固有肌层损伤。活体猪胃手术中,9处病变采用自制新型内镜多功能圈套器均完整切除,术后1周观察创面未见穿孔及出血;活体猪肠手术中,15处病变均完整切除,术后1周观察均有不同程度愈合,创面未见并发症,其中1处病变病理见固有肌层损伤(6.7%,1/15)。结论:自制新型多功能圈套器在猪胃肠电切术中应用安全有效,肠道手术建议设置20 W的低功率作为手术功率。

Objective:To investigate the feasibility,safety and efficacy of a novel endoscopic multi-functional snare for endoscopic resection of gastrointestinal lesions in a porcine model.Methods:The new endoscopic multi-function snare was used for endoscopic resectionin porcine stomach and porcine intestine in vitro or in vivo,respectively.Under condition of different electrical setting(20 W,30 W,40W),the stimulated resected lesions with diameter of about 1 cm were excised,followed by argon plasma coagulation for the wound.The complete resection rate,wound healing 1 week after resection(in vivo experiment),intraoperative and perioperative complications were observed and recorded.The resected lesions and the wounds were sent for pathological examination to observe the muscularis propria injury.Results:It was shown that all the 9 simulated lesions in the stomach were completely resected in vitro.The resection effect in the intestine in vitro was the best under the low power(20 W),while the escharosis of the intestinal mucosa was obvious under higher voltage settings,so low voltage setting was used in the further experiment in vivo.No muscularis propria injury was observed macroscopically and pathologically in vitro.In gastric surgery in vivo,all the 9 lesions were completely resected and no perforation or bleeding on the wound was observed 1 week after operation.In intestinal surgery in vivo,all the 15 lesions were completely resected,and healing of different degree was observed,no complication was found on the wound,muscularis propria damage was observed in 1 case(6.7%,1/15)1 week after operation.Conclusions:The new multi-functional snare is safe and effective in endoscopic resection in porcine model in vitro and in vivo.It is recommended to set the low power of 20 W during intestinal surgery.