生物蛋白胶和曲安奈德对犬食管内镜黏膜下剥离术后狭窄的预防

目的 探讨生物蛋白胶和曲安奈德对犬食管内镜黏膜下剥离术(endoscopic submucosal dissection,ESD) 后狭窄的预防效果.方法 健康12月龄普通家犬20只(雌雄不限,体质量12 ～15 kg) ,采用随机数字表法分为4组(n = 5): 联合治疗组、生物蛋白胶组、曲安奈德组和对照组,ESD术于食管距门齿30～34 cm处剥离食管黏膜3/4环周,建立创面,分别于创面喷涂生物蛋白胶+ 曲安奈德混悬液、生物蛋白胶溶液、曲安奈德溶液,对照组不用药物.术后6周胃镜检查后处死实验犬取食管标本观察大体形态、比较狭窄率,狭窄组织行HE染色和针对α-SMA的免疫组化染色.结果 胃镜下见狭窄处瘢痕皱襞.大体标本见瘢痕处管壁变薄.相比曲安奈德组(P＜ 0.05) 和对照组(P＜ 0.01) ,联合治疗组狭窄率更小;生物蛋白胶组较对照组狭窄率也更小(P＜ 0.05) .HE染色见黏膜下层广泛的肌成纤维细胞、胶原纤维和固有肌层萎缩.与联合治疗组比较,曲安奈德组和对照组α-SMA表达量均显著增加(P＜ 0.01);与生物蛋白胶组比较,曲安奈德组(P＜ 0.01) 和对照组(P＜ 0.05) 表达量也增加.结论 食管ESD术后创面局部喷涂生物蛋白胶+ 曲安耐德混悬液或生物蛋白胶对术后狭窄有预防效果,其机制可能与减少黏膜下层纤维化和炎症反应有关,而单次喷涂曲安奈德对术后狭窄无效.

Fibrin glue and triamcinolone acetonide prevent postoperative esophageal stenosis after endoscopic submucosal dissection in a canine model

Objective To investigate the preventive efficacy of fibrin glue supplementation with triamcinolone acetonide in a dog model of post-endoscopic esophageal dissection (ESD). Methods Twenty 12-month-old domestic dogs in good condition (both sexes, 12 to 15 kg), were randomly divided into 4 groups (n = 5): fibrin glue-triamcinolone acetonide treatment group (FT), fibrin glue treatment group (F), triamcinolone acetonide treatment group (T) and control group. ESD model was inflicted by exfoliating threequarters circumference of esophageal mucosa in 30 ～ 34 cm away from the incisor. Then fibrin glue suspensions with triamcinolone acetonide, fibrin glue solution or triamcinolone acetonide solution were correspondingly sprayed to cover the ulcer wound after ESD, respectively, and no drug was applied for the control group. Gross observation, stenosis rate, and HE staining and immunohistochemical examination of α-SMA for the stenosis tissues were performed in 6 weeks after ESD. Results Mucosal folds were sighted under endoscopy but in which a thinner esophageal wall was noted in macropathology. The dogs in the FT group gained a lower mucosal stenosis rate as to the dogs in the T group (P＜0.05) and control group (P＜0.01), and a similar lower rate happened in the comparison with the dogs from the F group to the control group (P＜0.05). HE staining displayed atrophy in the muscularis propria, extensive myofibroblasts and collagen fibers in submucosa layer in the control group. Compared with the FT group, the expression level of α-SMA was augmented in the T group and control group (P＜0.01), as well as in the T group (P＜0.01) and control group (P＜0.05) when compared with the F group. Conclusion Spraying fibrin gluetriamcinolone acetonide suspensions or fibrin glue alone can relieve esophageal post-ESD stenosis, probably via alleviating submucosa fibrosis and inflammation, but a single dose of triamcinolone acetonide does not work.