In vivo characterization of colonic thermal injury caused by argon plasma coagulation
In vivo characterization of colonic thermal injury caused by argon plasma coagulation
复制标题
DOI：
10.1067/mge.2002.123418
复制
发表时间：
2002-05-01
影响因子：
7.7
通讯作者：
Petersen, BT
中科院分区：
文献类型：
--
作者：
Norton, ID;Wang, LN;Petersen, BT
背景：氩离子凝固术已迅速被接受用于内镜下血管病变和浅表肿瘤的消融。人们认为，通过优先向非干燥组织释放能量来限制损伤深度。然而，氩等离子体凝固引起的损伤尚未得到很好的表征。本研究的目的是通过使用猪模型来表征氩等离子体凝固引起的结肠损伤。方法：对 6 只雌性猪进行剖腹手术，并在全身麻醉下将受试者的结肠取出。使用垂直于粘膜2毫米的氩等离子体凝固探针进行损伤。研究的变量如下：功率（45 W、60 W 和 75 W）和持续时间（1、2 或 3 秒；每个功率/持续时间组合 n = 11）。损伤分为浅表或深层，涉及固有肌肉。结果：循环肌层损伤与功率 (p = 0.02)、持续时间 (p = 0.001) 和传递的总能量 (r = 0.977) 密切相关。纵向肌肉损伤与烧伤持续时间（p = 0.001）和传递的总能量（r = 0.855）相关，但与功率相关性较差（p = 0.40）。没有发生穿孔。粘膜下注射盐水溶液具有保护作用，可减少环肌损伤（90% 至 10%，p = 0.002）和纵向肌肉损伤（50% 至 0%，p = 0.1）。结论：在推荐的氩气等离子凝固设置下，固有肌层会发生损伤。伤害与功率设置、燃烧持续时间和总能量输送有关。对非干燥组织的保护性电弧在体内似乎并不显着。粘膜下注射盐水溶液可防止深度损伤。
Background: Argon plasma coagulation has been rapidly accepted for endoscopic obliteration of vascular lesions and superficial tumors. Depth of injury is thought to be limited through preferential discharge of energy to nondesiccated tissue. However, argon plasma coagulation-induced injury has not been well characterized. The aim of this study was to characterize argon plasma coagulation-induced colonic injury by using a porcine model.Methods: Laparotomy was performed in 6 female swine and the colon exteriorized with the subjects under general anesthesia. Lesions were made with an argon plasma coagulation probe held perpendicular and 2 mm from the mucosa. Variables studied were as follows: power (45 W, 60 W, and 75 W) and duration (1, 2, or 3 seconds; n = 11 for each power/duration combination). Injury was graded as either superficial or deep, involving the muscular-is propria.Results: Circular muscle layer injury correlated closely with power (p = 0.02), duration (p = 0.001), and total energy delivered (r = 0.977). Longitudinal muscle damage was associated with duration of burn (p = 0.001) and total energy delivered (r = 0.855), but correlated poorly with power (p = 0.40). No perforations occurred. Submucosal injection of saline solution had a protective effect with reductions in circular (90% to 10%, p = 0.002) and longitudinal muscle injury (50% to 0%, p = 0.1).Conclusions: Injury to the muscularis propria occurs at recommended settings for argon plasma coagulation. Injury correlates with power setting, duration of burn, and total energy delivery. Protective arcing to nondesiccated tissue does not appear to be significant in vivo. Submucosal injection of saline solution protects against deep injury.