Gong Eun Jeong, Ahn Ji Yong, Jung Hwoon-Yong, Park Young Soo, Na Hee Kyong, Jung Kee Wook, Kim Do Hoon, Lee Jeong Hoon, Choi Kee Don, Song Ho June, Lee Gin Hyug, Kim Jin-Ho
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
J Gastroenterol Hepatol. 2017 May;32(5):1040-1045. doi: 10.1111/jgh.13636.
Argon plasma coagulation (APC) is a safe alternative treatment for gastrointestinal neoplasms and precancerous lesions. However, the extent of thermal damage after APC is difficult to predict. We investigated the effects of APC on human stomach tissue.
Argon plasma coagulation was performed on 10 freshly resected human stomachs that were obtained after total gastrectomy. The effects on tissue were compared across power settings (40, 60, and 80 W), durations (5, 10, 15, 20, and 25 s), and between injection (submucosal injection of normal saline) and control (without injection) groups. Success was defined as complete mucosal necrosis without damaging the muscularis propria.
Without submucosal injection, the incidence of damaging the muscularis propria increased as the power and duration increased. Tissue damage in the injection group was mostly confined to the submucosa, even when using the high-power setting. In the injection group, ablations at 40 W for 20 s, 60 W for 15 s, and 80 W for 15 or 20 s produced success rates ≥80%. In the control group, ablations at 60 W for 10 s, and 80 W for 5, or 10 s produced success rates ≥80%. The optimal energy levels to achieve complete mucosal and submucosal necrosis without damaging the muscularis propria were 800-1600 and 600-800 J in the injection and control groups, respectively.
Application of APC produces good results with a low risk of perforation.
氩等离子体凝固术（APC）是治疗胃肠道肿瘤及癌前病变的一种安全的替代疗法。然而，APC术后热损伤的范围难以预测。我们研究了APC对人胃组织的影响。
对10例全胃切除术后新鲜切除的人胃进行氩等离子体凝固术。比较不同功率设置（40、60和80W）、持续时间（5、10、15、20和25秒）以及注射组（黏膜下注射生理盐水）和对照组（未注射）对组织的影响。成功定义为完全黏膜坏死且不损伤固有肌层。
未进行黏膜下注射时，随着功率和持续时间的增加，损伤固有肌层的发生率增加。即使使用高功率设置，注射组的组织损伤大多局限于黏膜下层。在注射组中，40W持续20秒、60W持续15秒、80W持续15或20秒的消融成功率≥80%。在对照组中，60W持续10秒、80W持续5或10秒的消融成功率≥80%。在注射组和对照组中，实现完全黏膜和黏膜下坏死且不损伤固有肌层的最佳能量水平分别为800 - 1600焦耳和600 - 800焦耳。
应用APC效果良好，穿孔风险低。
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