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。

Study on safety of argon plasma coagulation with submucosal injection for colon polyps

Objective To investigate the safety of argon plasma coagulation （APC） with submuco- sal injection for colon polyps. Methods A total of 30 sets of fresh sigmoid colon from healthy pigs were as- signed to control group to receive direct APC, and to treatment group to receive APC with submucosal injec- tion, respectively. After same time and energy of APC, each specimen was sampled for pathological evalua- tion and the damage extent was determined as mucosa, submucosa （superior 1/3, middlel/3, inferior 1/3）, and muscularis propria. Ten cases of colon sessile polyps with diameter of about 1-2 cm, elevated within 3ram by endoscopic ultrasonography（EUS）. Direct APC or APC with submucosal injection were per- formed, respectively, and the difference was observed by EUS. Results In 30 cases of control group, the injury depth of 5 cases reached to the muscularis propria and of 25 cases to submucosa layer, among which 4 cases showed damage to superior submucosa 12 middle submucosa and 9 inferior submucosa. In 30 cases of treatment group, there was no damage to muscularis propria. The injury depth of 26 cases reached submucosa layer, among which 22 cases showed damage to superior submucosa, 4 middle submucosa. The results showed significant difference between two groups （P 〈0. 01 ）. In patients who underwent APC with submu- cosal injection, EUS showed effective isolation of mucosa and muscularis propria. It confined the injury to the mucosal layer. Without treatment of submucosal injection in advance, it seemed easier to damage the submucosa and muscularis propria. Conclusion Submucosal injection can protect the colon injured by APC, and may reduce the risk of colon perforation by APC for colon polyps.