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目的探讨经内镜下黏膜剥离术(ESD)后,创面应用聚羟基乙酸(PGA)膜的效果及在人体消化道管腔内应用的安全性。方法选取解放军总医院2016年3月至4月因上消化道早癌接受ESD治疗的26例患者为研究对象,以创面是否覆盖PGA膜随机分为覆膜组和对照组。分析两组间术后并发症的发生情况、创面愈合程度、肝肾功能及血常规的改变,对比不同的固定方式对PGA膜与创面的贴合情况。结果对照组和覆膜组术后均无并发症发生。覆膜组术后1个月创面愈合度明显优于对照组(P<0.05)。术后1周、1个月化验血常规、肝肾功能对照组及覆膜组均无异常,两组间数值变化无统计学差异(P>0.05)。覆膜组13例患者,根据ESD创面大小覆盖PGA膜,分别采用钛夹、猪源性纤维蛋白黏合剂、钛夹+猪源性纤维蛋白黏合剂进行固定;术后1周内镜检查:PGA膜在食管创面的全部脱落,而在贲门及胃的均在位,猪源性纤维蛋白黏合剂固定的PGA膜与创面贴敷完好(4/4),钛夹固定的PGA膜与创面部分不能完全贴合(3/6)。1例贲门早癌患者术中出现穿孔,使用PGA膜进行了修补,后顺利完成ESD术,术后无并发症发生,1周后复查创面完整。结论 ESD术后应用PGA膜可促进创面愈合;猪源性纤维蛋白黏合剂固定PGA膜的方式可使之更加贴合创面;PGA膜可用来修补ESD术中穿孔,但PGA膜在ESD创面的临床疗效有待进一步的研究。
Objective To investigate the effect of polyglycolic acid (PGA) on wound surface and its safety in the digestive tract after endoscopic mucosal dissection (ESD). Methods Twenty-six patients with ESD treated by the upper gastrointestinal tract cancer from March 2016 to April 2016 in the People’s Liberation Army General Hospital were enrolled in this study. The patients were randomly divided into plastic-covered group and control group. The incidence of postoperative complications, the degree of wound healing, liver and kidney function and blood routine changes between the two groups were analyzed. The fit of PGA film to the wound was compared between different fixation methods. Results There were no complications in the control group and the laminating group after operation. The degree of wound healing at 1 month after operation in the laminating group was significantly better than that in the control group (P <0.05). After 1 week, 1 month blood test, liver and kidney function control group and laminating group were normal, there was no significant difference between the two groups (P> 0.05). According to the thickness of the ESD wound, 13 patients were covered with PGA membrane and fixed with titanium clips, pig-derived fibrin glue and titanium clip + pig-derived fibrin glue respectively. Endoscopic examination of PGA Membrane in the esophageal wound all the fall, and in the cardia and stomach are in place, porcine fibrin glue fixed PGA film and wound paste intact (4/4), titanium clip fixed PGA film and the wound part can not Fully fit (3/6). Perforation was performed in 1 case of cardia cancer, and repaired with PGA membrane. ESD was successfully completed after surgery. No complications occurred after operation, and the wound surface was intact after 1 week. Conclusion The application of PGA membrane after ESD can promote the healing of wounds. The pigmentation of PGA membrane with pig-derived fibrin glue can make it more suitable for wound healing. PGA membrane can be used to repair perforation in ESD, but the clinical application of PGA membrane in ESD wound Curative effect needs further study.