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目的将类弹性蛋白多肽(ELP)作为一种黏膜下注射液应用于内镜黏膜下剥离术(ESD),对其有效性进行评估,为临床应用提供依据。方法 54只雄性SD大鼠随机分为3组(n=18)。第一组观察不同注射液分离组织的有效性。根据注射不同的注射剂随机分为3个亚组(n=6),暴露胃后壁分别黏膜下注射ELP、透明质酸钠(SH)和生理盐水(NS)0.2mL,观察并记录药物注射后0、5、10、30及60min局部黏膜隆起厚度及黏膜表面的改变;第2组观察注射不同注射液后30min黏膜隆起的组织学表现(n=6);第3组观察黏膜下剥离时不同注射液对出血的影响。根据注射不同注射剂随机分为3个亚组(n=6)。给予上述注射剂处理后,用无菌手术刀片完整切除黏膜下注射后形成的隆起部位,测定黏膜切除20min内的出血量。结果注射药物后60min内黏膜隆起厚度比较:ELP组分别与SH和NS组相比差异有显著性(P<0.05),即ELP维持黏膜隆起厚度明显大于SH和NS;SH与NS组相比差异有显著性(P<0.05),即SH维持黏膜隆起厚度大于NS。组织学观察ELP注射部位的周围组织中未见明显的炎性细胞浸润及坏死。黏膜切除时的出血量:ELP组、SH组、NS组分别为(854.0±98.9)、(726.3±104.8)和(1144.0±112.4)mg,ELP、SH组分别与NS组相比差异有显著性(P<0.05),应用ELP与SH较NS可明显减少出血量。结论黏膜下注射ELP后,ELP在黏膜下组织中的弥散明显延缓,在黏膜下形成较持久的液体垫维持黏膜厚度,有利于黏膜组织的剥离切除,并可以减少出血量,因此ELP有可能作为ESD中较为理想的黏膜下注射剂应用于临床。
Objective Elastin polypeptide (ELP) is used as a submucosal injection in endoscopic submucosal dissection (ESD) to evaluate its effectiveness and provide a basis for clinical application. Methods 54 male SD rats were randomly divided into 3 groups (n = 18). The first group observed the effectiveness of different injection of tissue isolated. According to the injection of different injection were randomly divided into three subgroups (n = 6), the submucosal exposure to the stomach after ELP, sodium hyaluronate (SH) and saline (NS) 0.2mL, observed and recorded after drug injection 0, 5, 10, 30, and 60 min. The histological changes of mucosal mucosa at 30 min after injection were observed in group 2 (n = 6). The changes of submucosal detachment in group 3 Effect of injection on bleeding. According to injection of different injection were randomly divided into 3 subgroups (n = 6). After the above injection was given, the bursting site formed after submucosal injection was completely removed with a sterile scalpel blade to measure the amount of bleeding within 20 min of mucosal resection. Results Compared with the SH and NS groups, the thickness of the mucosal uplift in the ELP group was significantly different (P <0.05), that is, the thickness of the mucosal uplift of the ELP group was significantly larger than that of the SH and NS groups (P <0.05), that is, the thickness of mucosal uplift of SH was higher than that of NS. Histological observation No obvious inflammatory cell infiltration and necrosis were found in the surrounding tissues of ELP injection site. The amount of bleeding during mucosal resection was (854.0 ± 98.9), (726.3 ± 104.8) and (1144.0 ± 112.4) mg respectively in ELP group, SH group and NS group, but there was significant difference between ELP group, SH group and NS group (P <0.05), the application of ELP and SH compared with NS can significantly reduce the amount of bleeding. Conclusion ELP submucosal injection of ELP in submucosal tissue was significantly delayed diffusion in the submucosa to form a more durable liquid pad to maintain mucosal thickness is conducive to dissection of mucosal resection and can reduce the amount of bleeding, so ELP may be as ESD is the ideal submucosal injection used in clinical.