Bures Jan, Kopácová Marcela, Kvetina Jaroslav, Osterreicher Jan, Sinkorová Zuzana, Svoboda Zbynek, Tachecí Ilja, Filip Stanislav, Spelda Stanislav, Kunes Martin, Rejchrt Stanislav
Second Department of Internal Medicine, Charles University in Praha, Faculty of Medicine at Hradec Králové, University Teaching Hospital, Sokolská 581, 500 05, Hradec Králové, Czech Republic.
Surg Endosc. 2009 Sep;23(9):2094-101. doi: 10.1007/s00464-008-0207-3. Epub 2008 Dec 5.
We hypothesised that different solutions for submucosal injection may influence early healing of endoscopic mucosal resection (EMR). The aim of this study was to evaluate histological and immunological changes after EMR in experimental pigs.
Two parallel EMRs on the anterior and posterior wall of the gastric body were performed by means of the cap technique in 21 female pigs. A glycerol-based solution (anterior EMR) and hydroxypropyl methylcellulose solution (posterior EMR) were applied for submucosal injection. The animals were sacrificed 7 days later, and tissue sections of all EMRs were stained using combined trichrome. Computer image analysis was used for objective evaluation of elastic and collagen fibres content. Two-colour indirect immunophenotyping of blood and gastric samples were performed using mouse anti-pig monoclonal antibodies.
The values of collagen fibre content 7 days after EMR were significantly higher in lesions after the use of solution A in comparison with solution B (2.10 +/- 0.25% versus 1.57 +/- 0.25%, p = 0.009). Concordant results were found in elastic fibres (3.23 +/- 0.49% versus 2.93 +/- 0.61%, p = 0.018). No systemic changes in major leukocyte subpopulations were found. In gastric tissue, lymphocyte subsets exhibited only minor changes. CD4(+) T-lymphocytes were increased in the healing tissue after EMR using solution A (17.08 +/- 9.24% versus 9.76 +/- 7.97%, p = 0.011). Significant increase of SWC3(+) leukocytes was observed after EMR using solution B (47.70 +/- 25.41% versus 18.70 +/- 12.16%, p = 0.001).
The use of glycerol-based solution for submucosal injection was associated with more pronounced histological signs of early healing of EMRs compared with hydroxypropyl methylcellulose.
我们推测，用于黏膜下注射的不同溶液可能会影响内镜黏膜切除术（EMR）的早期愈合。本研究的目的是评估实验猪EMR术后的组织学和免疫学变化。
采用帽状技术，在21头雌性猪的胃体前壁和后壁进行了两次平行的EMR。分别使用甘油基溶液（前壁EMR）和羟丙基甲基纤维素溶液（后壁EMR）进行黏膜下注射。7天后处死动物，所有EMR的组织切片采用三色联合染色。计算机图像分析用于客观评估弹性纤维和胶原纤维含量。使用小鼠抗猪单克隆抗体对血液和胃样本进行双色间接免疫表型分析。
与溶液B相比，使用溶液A后EMR术后7天的胶原纤维含量值显著更高（2.10±0.25%对1.57±0.25%，p = 0.009）。弹性纤维也得到了一致的结果（3.23±0.49%对2.93±0.61%，p = 0.018）。未发现主要白细胞亚群的全身变化。在胃组织中，淋巴细胞亚群仅表现出轻微变化。使用溶液A进行EMR后，愈合组织中的CD4(+) T淋巴细胞增加（17.08±9.24%对9.76±7.97%，p = 0.011）。使用溶液B进行EMR后，观察到SWC3(+)白细胞显著增加（47.70±25.41%对18.70±12.16%，p = 0.001）。
与羟丙基甲基纤维素相比，使用甘油基溶液进行黏膜下注射与EMR早期愈合更明显的组织学征象相关。
