Sato Tomoyuki
Department of Surgery, International University Hospital of Health and Welfare, International University of Health and Welfare, Iguchi 537-3, Nasushiobara-shi, Tochigi-ken 329-2763, Japan.
Dis Colon Rectum. 2006 Oct;49(10):1636-41. doi: 10.1007/s10350-006-0680-5.
Endoscopic mucosal resection assisted by submucosal injection of saline is a widely used procedure; however, it has three limitations: 1) it often is difficult to maintain a desirable level of tissue elevation after the injection; 2) the saline has no efficacy in preventing hemorrhage; 3) nothing can protect the site of mucosal defect after endoscopic mucosal resection to prevent perforation. Blood, as a new medium for use in submucosal injection, may remedy these drawbacks. This is the first report of this technique.
From May to October 2004, 28 outpatients (8 females; median, 64 years) with 35 colorectal polyps (median, 5 mm in diameter; range, 1-30 mm) were enrolled in this study. Technique of the blood patch endoscopic mucosal resection: after autologous blood was injected into the submucosa under the lesion using a disposable 23-gauge needle, the lifted mucosa with the lesion was removed using a conventional snaring technique. The outcomes were prospectively studied.
Although one lesion was not lifted by the submucosal injection because of the submucosal invasion of carcinoma, 33 of the other 34 lesions (97.1 percent) were successfully completed using the blood patch endoscopic mucosal resection. The clot covered the raw surface after the endoscopic mucosal resection without bleeding. No complications (including hemorrhage and perforation) were observed. The blood patch endoscopic mucosal resection did not disturb pathologic examination.
Endoscopic mucosal resection assisted by submucosal injection of autologous blood can be performed safely, easily, and economically. Autologous blood is a promising medium for submucosal injection on endoscopic mucosal resection.
黏膜下注射生理盐水辅助内镜黏膜切除术是一种广泛应用的手术方法；然而，它有三个局限性：1）注射后常难以维持理想的组织隆起水平；2）生理盐水在预防出血方面无效；3）内镜黏膜切除术后没有任何东西可以保护黏膜缺损部位以防止穿孔。血液作为一种用于黏膜下注射的新介质，可能弥补这些缺点。这是关于该技术的首次报告。
2004年5月至10月，28例门诊患者（8例女性；中位年龄64岁）患有35个结直肠息肉（中位直径5mm；范围1 - 30mm）被纳入本研究。血液补片内镜黏膜切除术技术：使用一次性23号针头将自体血注射到病变下方的黏膜下层后，用传统圈套技术切除带有病变的隆起黏膜。对结果进行前瞻性研究。
尽管由于癌的黏膜下浸润，一个病变未因黏膜下注射而隆起，但其他34个病变中的33个（97.1%）使用血液补片内镜黏膜切除术成功完成。内镜黏膜切除术后血凝块覆盖创面且无出血。未观察到并发症（包括出血和穿孔）。血液补片内镜黏膜切除术不影响病理检查。
黏膜下注射自体血辅助内镜黏膜切除术可以安全、简便且经济地进行。自体血是内镜黏膜切除术中用于黏膜下注射的一种有前景的介质。
