Heimann T M, Kurtz R J, Shen S, Aufses A H
Am J Surg. 1984 Jun;147(6):803-6. doi: 10.1016/0002-9610(84)90206-x.
Mucosal proctectomy is becoming the operation of choice in the surgical treatment of patients with ulcerative colitis and familial polyposis coli. Dissection of the rectal mucosa and submucosa from the underlying muscularis is often difficult and, in some instances, impossible to perform. The feasibility of using an ultrasonic device to perform mucosal protectomy was studied in eight dogs. This technique produced coagulative necrosis of the mucosa and muscularis mucosa with marked edema and congestion of the submucosa. The muscularis propria remained intact. Complete destruction of the distal 7 cm of rectal mucosa required a total duration of exposure to the ultrasonic probe of at least 12 minutes. In another five dogs, total colectomy was performed above the area of the mucosal proctectomy followed by endorectal pull-through of the ileum. Follow-up studies revealed healing of the ileonal anastomosis without retraction or stricture. This technique should allow mucosal proctectomy to be performed in those patients in whom standard dissection is not possible due to fibrosis of the submucosal plane.
黏膜直肠切除术正成为溃疡性结肠炎和家族性结肠息肉病患者外科治疗的首选手术方式。从其下方的肌层分离直肠黏膜和黏膜下层通常很困难，在某些情况下甚至无法进行。在八只狗身上研究了使用超声设备进行黏膜直肠切除术的可行性。该技术导致黏膜和黏膜肌层发生凝固性坏死，黏膜下层出现明显水肿和充血。固有肌层保持完整。完全破坏直肠黏膜远端7厘米需要超声探头的总暴露时间至少为12分钟。在另外五只狗身上，在黏膜直肠切除术区域上方进行全结肠切除术，随后进行回肠经直肠拖出术。随访研究显示回肠吻合口愈合，无回缩或狭窄。对于因黏膜下层平面纤维化而无法进行标准分离的患者，这项技术应能实现黏膜直肠切除术。
