インドシアニングリーンを用いた食道静脈瘤の半導体レーザー治療

内窥镜硬化治疗和静脉曲张结扎术被广泛接受为治疗食道静脉曲张的首选方法。然而，其安全性和有效性尚未完全实现。我们开发了ICG增强型半导体激光光硬化疗法作为预防食道静脉曲张出血的治疗方法。黏膜下注射波长特异性染料(ICG：吲哚青绿)可选择性地在食道静脉曲张周围的粘膜下组织中提供增强的半导体激光吸收。首先，我们通过实验阐明了这项新技术的有效性和安全性，并将其应用于6例食道静脉曲张。在实验研究中，选择性地诱导粘膜和粘膜下层的热损伤，在照射过程中没有表面缺陷。随访1个月，光镜下可见黏膜及粘膜下层变性，取而代之的是纤维化，而肌层未见明显改变。基于这些发现，我们将这项技术应用于6例EVL治疗后的食道静脉曲张患者。所有病例均在2周内完全根除。2例轻度狭窄，易行球囊扩张。结论：ICG染料增强型半导体激光光固化疗法是预防食道静脉曲张出血的一种简单、安全、有效的方法。

Endoscopic sclerotherapy and variceal ligation are widely accepted as the first choice of treatment for esophageal varices. However, its safety and efficacy has not been completely achieved yet.We developped ICG enhanced diode laser photosclerotherapy as preventive treatment for bleeding esophageal varices. Submucosal injection of wave length-specific dye (ICG : indocyanine green) could provide enhanced diode laser beam absorbtion selectively in the submucosal tissues around esophageal varices. First of all, we clarified the efficacy and safety of this new technique esperimentally using dog's esophagus and then applied it in 6 cases of esophageal varices. In the experimentally study, thermal injuries in the mucosa and submucosa were selectively induced without surface defects during irradiation. A month follow up e*oscopy showed degenerated mucosa and submucosa to be replaced with fibrosis while no changes were observed in the muscle layer. Based on these findings, we therefore, applied this technique in 6 patients of esophageal varices after EVL treatment. Complete eradication was archieved within 2 weeks in all cases. A mild stenosis was seen in 2 patients, which was easily treated by balloon dilatation. It is concluded that ICG dye enhanced diode laser photosclerotherapy would be useful as a simple, safe and effective alternative to prevent bleeding from esophageal varices.