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[犬肠道缺血性病变的实验性内镜研究——特别关注荧光内镜检查]

[An experimental endoscopic study on intestinal ischemic lesions in dogs with special reference to fluorescence endoscopy].

作者信息

Iwata S

机构信息

2nd Department of Surgery, Tokyo Medical and Dental University, Japan.

出版信息

Nihon Geka Gakkai Zasshi. 1988 Jul;89(7):1014-21.

PMID:3221823
Abstract

In order to clarify the pathophysiology of intestinal ischemic lesions and to make a useful method for the prediction of fate of the ischemic bowel, we devised an experimental model to produce the disorder. Microbarium of 0.5 micrometer in diameter was injected into a branch of the superior mesenteric artery of adult mongrel dogs. The severity of the ischemic lesions depended on the amount of microbarium injected, and lesions could be classified into three types; transient, stricturing and gangrenous, similar to clinical cases. Endoscopic examination was performed, accompanied with fluorescence endoscopy. Fluorescein could not be observed in all types soon after microbarium injection. In the transient type, fluorescein was observed after only a few days in an evenly distributed pattern. However in the stricturing type, the appearance of fluorescein was delayed, and an irregular pattern was observed in about 1 week. The submucosal blood flow was measured by hydrogen clearance method. The fluorescence endoscopic findings were nearly compatible with changes of submucosal blood flow. Fluorescence endoscopy is easily performed and appears to be highly useful in the differentiation of these three types of ischemia in the early stages.

摘要

为了阐明肠道缺血性病变的病理生理学,并找到一种预测缺血肠管转归的有效方法,我们设计了一个实验模型来引发这种病症。将直径为0.5微米的微钡剂注入成年杂种狗肠系膜上动脉的一个分支。缺血性病变的严重程度取决于注入微钡剂的量,病变可分为三种类型:短暂性、狭窄性和坏疽性,与临床病例相似。进行了内镜检查,并伴有荧光内镜检查。微钡剂注射后不久,在所有类型中均未观察到荧光素。在短暂性类型中,仅在几天后就观察到荧光素呈均匀分布。然而,在狭窄性类型中,荧光素的出现延迟,约1周后观察到不规则分布。采用氢清除法测量黏膜下血流量。荧光内镜检查结果与黏膜下血流量的变化几乎一致。荧光内镜检查操作简便,在早期区分这三种类型的缺血方面似乎非常有用。

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