Kojima Y, Sanada Y, Fonkalsrud E W
Surg Gynecol Obstet. 1982 Dec;155(6):849-54.
Rectal mucosectomy may be technically difficult to perform on certain patients with severe ulcerative colitis involving the rectum, in whom a colectomy and endorectal ileal pull-through operation is planned. The present study evaluates the effectiveness of the following caustic agents in causing severe injury to the colonic mucosa of dogs after ten minutes of exposure, as determined by light and scanning electron microscopy: 1.0 normal sodium hydroxide; 0.5 normal sodium hydroxide; 1.25 per cent formalin solution, and silver nitrate sticks. The 1.0 normal sodium hydroxide solution caused injury to both mucosa and muscularis. The 0.5 normal sodium hydroxide produced mucosal injury without damage to the muscularis; the mucosa could be rubbed off with minimal bleeding. Although the mucosa exposed to 1.25 per cent formalin solution or to silver nitrate sticks showed varying degrees of injury, the remaining mucosa was not readily removed by rubbing. Repeat exposure of the mucosa to 0.5 normal sodium hydroxide three days after the first exposure made it easy to remove the mucosa by gentle rubbing but did not cause gross or microscopic injury to the muscularis. Chemical debridement of colonic or rectal mucosa may be a helpful adjunct when the mucosa cannot be removed readily by standard surgical dissection during endorectal pull-through operations.
对于某些患有累及直肠的重度溃疡性结肠炎且计划进行结肠切除术和直肠内回肠拖出术的患者，直肠黏膜切除术在技术上可能难以实施。本研究评估了以下苛性剂在暴露十分钟后对犬结肠黏膜造成严重损伤的有效性，这是通过光学显微镜和扫描电子显微镜确定的：1.0当量的氢氧化钠；0.5当量的氢氧化钠；1.25%的福尔马林溶液和硝酸银棒。1.0当量的氢氧化钠溶液对黏膜和肌层均造成损伤。0.5当量的氢氧化钠造成黏膜损伤但未损伤肌层；黏膜可以很容易地被擦去，出血很少。尽管暴露于1.25%福尔马林溶液或硝酸银棒的黏膜显示出不同程度的损伤，但剩余的黏膜不容易通过擦拭去除。首次暴露三天后，将黏膜再次暴露于0.5当量的氢氧化钠，使得通过轻轻擦拭就很容易去除黏膜，且未对肌层造成肉眼可见或显微镜下的损伤。当在直肠内拖出术中通过标准手术解剖难以轻易切除黏膜时，结肠或直肠黏膜的化学清创术可能是一种有用的辅助方法。
