Comparison between tungsten and steel polypectomy snares: evaluation of depth of colonic thermal wall injury in a pig model
Comparison between tungsten and steel polypectomy snares: evaluation of depth of colonic thermal wall injury in a pig model
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DOI：
10.1055/s-0032-1325930
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发表时间：
2013-02-01
期刊：
影响因子：
9.3
通讯作者：
Carlomagno, G. M.
中科院分区：
文献类型：
--
作者：
Galloro, G.;Magno, L.;Carlomagno, G. M.
背景和研究目的：息肉切除术中结肠壁的热损伤可导致出血、穿孔等并发症。到目前为止，陷阱材料在这些伤害中的作用还没有被研究过。本研究的目的是评估钨和钢丝内窥镜下陷阱对结肠息肉切除术后热壁损伤的深度，以减少与电外科相关的并发症。材料和方法：这是一项单中心的猪模型实验研究。三只活猪在全身麻醉下，采用切割、凝固和混合电流模式，使用钢夹和钨夹，共施行90例息肉切除术。结果：纯切模式下，钢套圈套的组织损伤深度明显大于钨套(Pearson chi(2)=6.136，P=0.013)。有序Logistic回归分析显示，当前使用的方式和诱捕材料与创伤深度的有序评分显著相关。因此，切割模式与较低的评分呈正相关，而凝血模式与较高的评分呈正相关。此外，钨与较低的组织损伤深度显著相关。结论：由于其固有的电学性质，钨非常适合用于制造电外科内窥镜设备。因此，钨丝圈套在内窥镜息肉切除术中的常规使用可能是有利的，尽管还需要进一步的研究来证实这些在人类患者中的有希望的发现。
Background and study aims: Thermal injury of the colonic wall during polypectomy may induce complications such as bleeding and perforation. To date, the role of the snare material in these injuries has not been examined. The aim of this study was to evaluate the depth of colonic post-polypectomy thermal wall injury induced by tungsten and steel endoscopic snares, in an effort to reduce electrosurgery-related complications.Materials and methods: This was a single tertiary center experimental study in a porcine model. A total of 90 polypectomies where performed in three live pigs under general anesthesia, using both steel and tungsten snares by cut, coagulation, and blend current modes. The pigs were then euthanized and their colons examined histologically.Results: Steel snares induced significantly deeper tissue injury than tungsten snares in the pure cut mode (Pearson chi(2) = 6.136, P= 0.013). The ordinal logistic regression analysis showed that the current mode and snare material were significantly associated with the ordinal score for the depth of injury. Thus, cut mode was positively associated with a lower score and coagulation mode with a higher score. In addition, tungsten was significantly associated with a lower depth of tissue injury.Conclusions: Due to its inherent electrical properties, tungsten is very well suited for manufacture into electrosurgical endoscopic devices. Thus, tungsten snares may be advantageous for routine use in endoscopic polypectomy, although further studies are needed to confirm these promising findings in human patients.