氩离子凝固术治疗消化道出血和息肉的疗效及监护

目的 探讨内镜下氩离子凝固术(APC）治疗消化道出血及息肉的临床价值及护理体会。方法 采用德国ERBE公司生产的APC300型氩气刀对消化道出血及息肉进行氩离子凝固术，并对所有病人加强术前、术中、术后的护理。结果 14例上消化道出血病人经治疗后12例未再出血，2例病人再出血。34例消化道息肉病人经APC治疗全部治愈。结论 APC治疗消化道出血及息肉疗效确切、安全性好、副作用小，有较高的临床价值。通过加强对病人的护理，可减轻病人的精神负担，保证手术顺利，防止术后并发症的发生。     

氩离子凝固术治疗消化道息肉20例

目的探讨内镜下氩离子凝固术（APC）对于消化道息肉的治疗作用。方法对20例患者85枚消化道息肉行内镜下APC治疗，氩气流量设定为2L／min，功率40～60w，治疗1周后复查。结果20例患者经1—4次治疗息肉均消失，治疗过程中及治疗后无明显的副作用。结论APC治疗消化道息肉安全、方便、快捷、有效。     

氩离子凝固器内镜下治疗的探讨

目的 通过对52例不同消化道疾病的内镜下氩离子凝固术（APC）治疗结果的回顾分析，评估其疗效及安全性。方法 2001年4月对2002年5月对52例门诊及住院患者因各种原因行内镜检查所发现的病变予以内镜下APC治疗，其中消化道出血者29例行止血治疗，消化道息肉样病变23例行APC切除治疗。结果 出血性溃疡中有1例因动脉性喷血而治疗失败转手术，其余均1次治疗成功，止血率达96．5％；对于小于5mm的息肉仅用APC凝固即可清除，大息肉或腺瘤则需先行圈套器切除后再用APC处理残端组织，效果满意且用EndoCut高频电刀切除大的宽基腺瘤安全可靠。本组仅1例出现无症状的局部粘膜下气泡。结论 APC对于大多数大门脉高压性的消化道出血止血效果满意，但对较大口径的动脉性出血则有疑问。APC结合智能电刀处理各种消化道息肉样病变安全可靠。     

氩离子凝固术治疗消化道息肉的应用价值

目的探讨氩离子凝固术的临床应用价值,评估其安全性及疗效。方法对2004年1月至2006年1月在哈尔滨医科大学附属第二医院消化內镜诊疗中心就诊的70例消化道息肉患者,采用德国ERBE公司生产的APC300EA型内镜下专用氩气刀,对广基扁平息肉进行经内镜下氩离子凝固术(APC)根除治疗。其中,直径在0.2~0.8cm广基、扁平息肉仅行APC切除治疗,直径在1.0~2.0cm的细蒂或粗蒂及宽基底大息肉行高频电切局部创面渗血,再行APC止血治疗。结果本组病例全部临床治愈。其中,一次成功切除50余枚息肉2例,20余枚2例,10余枚3例,仅用圈套器一次成功切除结肠多发有蒂大息肉30余枚2例。术后仅有2例患者出现无症状的局部黏膜下气泡,1周后复查无其他并发症发生。结论APC结合高频电切在各种消化道息肉病变治疗中安全性好,可有效止血,副反应少,操作简便,尤其是在扁平、广基息肉的治疗中可作为首选方法。     

内镜下氩离子凝固术治疗老年人大肠息肉

目的探讨内镜下氩离子凝固术（APC）治疗老年人大肠息肉的安全性和有效性。方法采用德国ERBE公司生产的APC（VIO200D型）内镜专用氩气刀对电子肠镜检查发现的大肠息肉进行内镜下治疗。结果258例老年患者共检出525枚息肉全部使用APC治愈,根据息肉大小和形态,使用APC灼除302枚（57．5％）,APC切除89枚（17％）,黏膜下注射后APC切除134枚（25．5％）,局部渗血者行APC电凝或钛夹止血。术后2例（0．8％）出现少量便血,予药物治疗后出血停止,无穿孔和大出血等严重并发症。结论APC可作为老年人大肠息肉的首选治疗,安全性高,并发症少。     

氩离子凝固术治疗消化道扁平隆起病灶43例

目的探讨氩离子凝固（APC）术治疗消化道扁平隆起病灶的疗效和安全性。方法选择我院2004-01/2005-05内镜诊断为消化道扁平隆起病灶病人43例。先行内镜检查，同时行病理组织学检查，排除恶性病变后，全部病例均入院治疗。根据病灶不同部位、大小、高低和数量采用不同的次数和时间施以氩离子凝固治疗，以内镜下所有瘸灶灼除后黏膜平坦或略凹为止。3个月后进行临床随访及内镜复查。结果APC治疗43例消化道扁平隆起病灶，病灶数共计74枚，平均每枚病灶治疗时间为4．85s（范围2．4-4.8s）。3个月后随访，40例（93%）病人临床症状明显改善，32例病人内镜复查，其中29例病灶消失，3例遗留残余病灶再行APC治疗后消失。结论与既往治疗消化道扁平隆起病灶的方法如激光、微波、热探头相比。APC术操作简便，易于掌握及并发症少，应用APC术为消除消化道扁平隆起病灶的一种有效方法。     

氩离子凝固术治疗十二指肠息肉的临床研究

目的探讨应用氩离子凝固术(APC)治疗十二指肠息肉的疗效及安全性,并与微波治疗十二指肠息肉的效果进行比较研究。方法选择2008年12月至2013年2月经胃镜检查确诊的151例十二指肠息肉患者按治疗方式随机分为两组:APC组75例,微波治疗组76例。观察比较两组患者的息肉根除率、并发症、治疗疗程及费用。结果(1)APC组和微波治疗组的息肉根除率分别为90.6%、66.9%,差异有非常显著性(P0.01);(2)APC组治疗期间有8例出现轻度的并发症,给予对症处理后消失,微波治疗组有18例出现糜烂,7例出现上消化道出血,对症治疗后痊愈;(3)两组患者住院时间比较无统计学差异(P0.05),微波治疗组住院费用高于APC组(P0.05)。结论氩离子凝固术治疗十二指肠息肉效果明显,副作用小,安全可靠,值得临床推广应用。     

氩离子凝固术联合中药治疗上消化道出血的临床研究

[目的]探讨内镜下氩离子凝固术（APC）联合自拟止血一号方治疗非静脉曲张性上消化道出血的临床疗效。[方法]对120例确诊为非静脉曲张性上消化道出血患者,在内镜下行APC止血,予以质子泵抑制剂、静脉补液等常规治疗后,随机分为2组：治疗组（60例）,在常规治疗的基础上加用自拟止血一号方煎剂口服;对照组（60例）仅予常规治疗。比较2组治疗总有效率及再出血率、死亡率、输血量、平均住院日、住院费用等指标。[结果]治疗组和对照组的总有效率分别为96．61％和88．33％（P〈0.05）;再出血率为3．33％和11．67％（P〈0.05）;死亡率为1．67％和5．00％（P〈0.05）;输血量为（2．34±2．05）U和（4．35±3．45）U（P〈0．05）;平均住院日为（10．59±4．88）d和（15．79±8．00）d（P〈0．05）;住院费用为（8．16±1．43）千元和（13．35±1．91）千元（P〈0．05）。[结论]APC联合中药治疗上消化道出血是一种疗效显著、死亡率及输血量低、住院天数短、经济实惠的治疗方法。     

内镜下应用氩离子血浆凝固术治疗早期食管癌及其癌前病变的临床研究

目的 探讨应用氩离子血浆凝固术治疗早期食管癌及其癌前病变的意义。方法1999年10月2003年1月内镜下应用氩离子血浆凝固术对13例早期食管癌及114例食管鳞状上皮异型增生进行治疗,氩离子血浆凝固术功率设定为28 W,氩气流量0.4 L／min。术后1个月、4个月及12个月进行内镜复查及治疗。结果 (1)氩离子血浆凝固术治疗早期食管癌及食管癌前病变的成功率分别为92.3％和100％,平均治疗次数分别为3次和2.2次。(2)本组127例合并症发生率为5.5％,其中早期癌与癌前病变合并症的发生率分别为30.7％和2.60％,合并症主要表现为出血、黏膜下血肿及发热等,经对症治疗后均治愈。本组无穿孔及狭窄发生。(3)4-12个月内镜复查并经病理证实3例早期癌复发,再次应用氩离子血浆凝固术治疗,2例治愈,1例病变未控改为手术治疗。癌前病变无复发。(4)本组术后平均随访时间为15.3个月,所有患者目前均无明显不适。结论 应用氩离子血浆凝固术可简便、安全、有效地治疗早期食管癌及癌前病变,具有较好的应用前景。     

内镜下氩离子凝固术治疗胃肠道多发性小息肉的护理

氩离子凝固术（Argon plasma coagulation,APC）作为一种新型非接触性内镜电凝固技术,因其具有操作简便、疗效确切、安全性高等优点,近年广为应用[1,2]。我院自2005年7月至2006年12月应用该技术治疗胃肠道多发性小息肉,效果明显。现将有关护理工作报告如下。[第一段]     

内镜下注射肾上腺素-盐水溶液分块摘除结直肠无蒂大息肉

目的探讨安全有效地在内镜下摘除结、直肠扁平无蒂大息肉。方法先在病变的基底部粘膜下层分点注射肾上腺素-盐水溶液,使病变部隆起,然后再在肠镜下用圈套分块电凝摘除。结果本院内镜室用此法治疗结直肠扁平无蒂息肉24例,所有病变直径均大于2cm,其中2～3cm17例,3.1～4cm6例,＞5cm1例。术后病理为腺瘤21例,早期大肠癌3例,均经内镜根治,经随访3例大肠癌均无复发。本组未出现出血或穿孔等并发症。结论结肠镜下注射肾上腺素-盐水溶液后,分块摘除扁平及无蒂的息肉是较安全、有效的o     

Argon plasma coagulation and radiofrequency ablation in nonvariceal upper gastrointestinal bleeding

Upper gastrointestinal bleeding (UGIB) is one of the most common causes of emergency department visits worldwide and represents a significant public health problem in many countries. Endoscopy plays a major role in the diagnosis and treatment of UGIB. Endoscopic hemostasis of peptic ulcer bleeding is preferably achieved by the combination of injection with contact thermal methods or mechanical methods. Argon plasma coagulation (APC) is a noncontact thermal method of hemostasis that has been employed to treat bleeding angioectasia. The use of APC in this situation presents satisfactory results with a low adverse event rate. APC presents the possibility to treat large bleeding areas in a single session. There is also a limited experience with the use of APC for peptic ulcer bleeding and bleeding from gastrointestinal neoplasia. More recently, radiofrequency ablation has been employed for the treatment of diffuse UGIB caused by angioectasias with promising results.     

氩离子凝固术对食管黏膜损伤的探讨

目的 探讨内镜下氩离子凝固术(APC)对食管黏膜的损伤程度。方法 在11例食管癌患者接受外科手术时,分别对其癌旁食管黏膜组织按不同功率(45 W、60 W、90 W)和不同时间(1s、3 s)进行APC烧灼。APC探头离黏膜组织约2 mm,呈约30°角,烧灼后的组织分别用光镜、电镜观察细胞及其超微结构,判断损伤程度。分析损伤程度与功率、时间的关系。结果 在55处APC烧灼后的组织切片标本中,46处仅累及黏膜层或黏膜下层,7处累及肌层,2处穿透全层。损伤深度与功率有关(P<0.01),与持续时间无明显关系(P>0.05)。结论 APC在内镜下治疗食管疾病时须将能量控制在一定范围以保证治疗的安全。     

黏膜切除术治疗结直肠广基隆起性腺瘤性息肉98例临床研究

目的探讨内镜下黏膜切除术(endoscopic mucosal resection,EMR)治疗结直肠广基隆起性腺瘤性息肉患者的疗效。方法回顾性分析98例结直肠广基隆起性腺瘤性息肉(息肉直径0.6~2.0 cm)患者的临床资料并行EMR治疗。结果 98例均经电子结肠镜检查及术前病理诊断为腺瘤性息肉,均为广基隆起性病变,共120枚,行EMR,留取完整标本病理检查,创面均给予钛夹封闭。术后病理诊断为腺瘤性息肉113例,高级别瘤变4例,局部癌变3例,7例切缘均无癌细胞,未追加外科手术。1个月后复查见病变部位黏膜光滑,未见息肉及病变黏膜残留。高级别瘤变及局部癌变7例随访3年,未见肿瘤复发及它处转移。结论对于广基隆起性腺瘤性息肉行EMR较既往单纯的高频电灼或氩离子凝固术有助于发现早期癌,改善患者的预后。     

氩离子凝固疗法在消化道疾病中的应用进展

氩离子凝固疗法是一种非接触性热消融疗法,近年在消化道疾病的内镜治疗中,应用越来越广。其既可以用于良性肿瘤和早期恶性肿瘤的根治性治疗,也可以用于进展期恶性肿瘤的姑息性治疗,还可用于Zenker憩室、放射性直肠结肠炎、放射性胃炎、Barrett食管、Dieulafoy溃疡、血管畸形出血、胆道支架远端移位或位置不良等疾病的治疗。同时也出现了胃出口梗阻、结肠爆炸等罕见并发症的报道。本文就氩离子凝固疗法的新应用和一些少见的并发症的发生情况进行综述。     

Argon plasma coagulation for superficial esophageal squamous-cell carcinoma in high-risk patients

AIM: To evaluate the usefulness and safety of argon plasma coagulation (APC) for superficial esophageal squamous-cell carcinoma (SESC) in high-risk patients. METHODS: We studied 17 patients (15 men and 2 women, 21 lesions) with SESC in whom endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and open surgery were contraindicated from March 1999 through February 2009. None of the patients could tolerate prolonged EMR/ESD or open surgery because of severe concomitant disease (e.g., liver cirrhosis, cerebral infarction, or ischemic heart disease) or scar formation after EMR/ESD and chemoradiotherapy. After conventional endoscopy, an iodine stain was sprayed on the esophageal mucosa to determine the lesion margins. The lesion was then ablated by APC. We retrospectively studied the treatment time, number of APC sessions per site, complications, presence or absence of recurrence, and time to recurrence.RESULTS: The median duration of follow-up was 36 mo (range: 6-120 mo). All of the tumors were macroscopically classified as superficial and slightly depressed type (0-Ⅱc). The preoperative depth of invasion was clinical T1a (mucosal cancer) for 19 lesions and clinical T1b (submucosal cancer) for 2. The median treatment time was 15 min (range: 10-36 min). The median number of treatment sessions per site was 2 (range: 1-4). The median hospital stay was 14 d (range: 5-68 d). Among the 17 patients (21 lesions), 2 (9.5%) had recurrence and underwent additional APC with no subsequent evidence of recurrence. There were no treatment-related complications, such as bleeding or perforation. CONCLUSION: APC is considered to be safe and effective for the management of SESC that cannot be resected endoscopically because of underlying disease, as well as for the control of recurrence after EMR and local recurrence after chemoradiotherapy.     

氩气刀结合黏膜下注射治疗结肠息肉的安全性研究

目的探讨氩气刀结合黏膜下注射治疗结肠息肉的安全性。方法取健康肉猪的新鲜乙状结肠30份,每份均设立实验组（黏膜下注射后氩气烧灼）和对照组（直接氩气烧灼）,烧灼后病理组织学观察猪结肠壁各层损伤情况并行组间对比分析。另选择10例结肠广基息肉患者（息肉直径1～2cm,厚度在3mm以内）,均分成观察组（黏膜下注射后氩气烧灼）和对照组（直接氩气烧灼）,烧灼后超声内镜观察人结肠壁各层损伤情况。结果病理组织学观察显示,对照组损伤猪结肠固有肌层5份、黏膜下层25份（上1／34份、中1／312份、下1／39份）,实验组损伤猪结肠黏膜下层26份（上1／322份、中1／34份）、黏膜肌层4份,2组差异有统计学意义（P〈0．01）。超声内镜观察显示：对照组人结肠黏膜层与黏膜下层融合、层次不清,局部黏膜下层与固有肌层边缘毛糙、不规则;观察组人结肠1、2层边缘稍毛糙模糊,其余各层层次界限清晰。结论黏膜下注射对氩气刀烧灼损伤具有保护作用,可减少结肠息肉患者氩气刀治疗发生穿孔的概率。     

Endoscopic mucosal resection of 161 cases of large sessile or flat colorectal polyps

Objective. Large sessile or flat colorectal polyps, which are traditionally treated surgically, may be amenable to endoscopic mucosal resection (EMR), often using a piecemeal method. Appropriate selection of lesions and a careful technique may enhance the efficacy of EMR for polyps ≥20 mm in diameter without compromising safety. The aim of this study was to identify the factors that may be predictive of the risk of polyp recurrence. Material and methods. A retrospective analysis was conducted on the outcome of 161 polyps ≥20 mm in diameter, treated by piecemeal EMR at a single centre using the “lift and cut” technique. All records were reviewed for polyp size, site, morphology and histology. Polypectomy technique, patient follow-up, polyp recurrence and surgical interventions were also recorded. Results. Over an 8-year period, 161 colonic polyps measuring ≥20 mm were removed by EMR. Follow-up data were available for 149 cases (93%) with a mean polyp diameter of 32.5 mm; the total success rate of endoscopic polyp removal was 95.4%. The number of cases requiring 1, 2, 3, 4 and 6 attempts at EMR was 89 (60%), 36 (24%), 14 (9%), 2 (1.3%) and 1 (0.7%), respectively. Recurrence was significantly related to polyp size (p<0.001). There was no statistically significant relationship between site and recurrence. Seven patients (4.6%) underwent surgical intervention after EMR because of failed clearance. There were no post-EMR perforations and significant bleeding was reported in only two patients (1.7%). Conclusions. With careful attention to technique, piecemeal EMR is a safe option for the resection of most sessile and flat colorectal polyps ≥20 mm in size. A stricter follow-up may be required for larger lesions because of a higher risk of recurrence.