Division of Endoscopy, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation Center for Research, Tokyo, Japan.
Dig Endosc. 2012 Sep;24(5):348-52. doi: 10.1111/j.1443-1661.2012.01244.x. Epub 2012 Apr 2.
In endoscopic mucosal resection (EMR), it is essential to inject submucosal fluid to prevent complications and ensure safe and complete en bloc resection of tumors. Sodium hyaluronate (SH) solution, which is effective in forming and maintaining a mucosal lift and is innocuous to mucosal tissue, is considered a useful injection solution for endoscopic submucosal dissection, a procedure associated with a high risk of perforation. This study was undertaken to assess the usefulness of this solution in EMR.
Ninety-four patients with colorectal tumors of ≤20 mm in diameter were enrolled for this study and randomized to a SH solution group (0.2% two-fold diluted MucoUp) or to a normal saline group (control). Ease of EMR was primarily assessed based on ease of submucosal injection, ease of snaring and injection time.
SH solution was superior to normal saline for ease of submucosal injection (57 ± 0.7 vs 50 ± 0.7; P < 0.05), and it showed better results for ease of snaring with less variability (63 ± 0.8 vs 51 ± 1.0; P < 0.05). The mean injection time was similar between the two groups (3.0 ± 9.0 s and 3.0 ± 2.7 s, respectively). Post-procedural hemorrhage occurred in 7% patients (3/46) injected with SH solution and in 6% of patients (3/48) in the control group; there was no significant difference between the groups.
Use of two-fold diluted MucoUp facilitated colorectal EMR.
在内镜黏膜切除术（EMR）中，注射黏膜下液对于预防并发症和确保肿瘤的安全、完整整块切除至关重要。透明质酸钠（SH）溶液在形成和维持黏膜抬举方面有效，且对黏膜组织无害，被认为是一种用于内镜黏膜下剥离术（一种穿孔风险较高的操作）的有用注射溶液。本研究旨在评估该溶液在 EMR 中的应用价值。
本研究纳入了 94 例直径≤20mm 的结直肠肿瘤患者，并将其随机分为 SH 溶液组（0.2% 2 倍稀释的 MucoUp）或生理盐水组（对照组）。主要根据黏膜下注射的容易程度、圈套器的易用性和注射时间来评估 EMR 的容易程度。
SH 溶液在黏膜下注射的容易程度（57±0.7 比 50±0.7；P<0.05）和圈套器的易用性（63±0.8 比 51±1.0；P<0.05）方面优于生理盐水，且注射时间的差异更小。两组的平均注射时间相似（分别为 3.0±9.0s 和 3.0±2.7s）。SH 溶液组的术后出血发生率为 7%（3/46），对照组为 6%（3/48），两组间无显著差异。
使用 2 倍稀释的 MucoUp 有利于结直肠 EMR。
