Johanns W, Jakobeit C, Luis W, Greiner L
Medizinische Klinik A, Klinikum Wuppertal, Universität Witten/Herdecke.
Z Gastroenterol. 1995 Dec;33(12):694-700.
Diathermocoagulation is indispensable in interventional endoscopy. The argon beam coagulation represents an innovative electrocoagulation method, where high-frequency alternating current is conducted to tissues by ionized argon gas without contact. Before clinical application we performed in vitro studies to evaluate depth and diameter of tissue coagulation of fresh resectations from stomach, small intestine and colon. Power and gas flow were graduated in five steps from 40 to 155 W and from 2 to 7 l/min respectively. Coagulation time (1 s-10 s) and angle of the probe in relation to tissue surface (45 degrees, 90 degrees) were varied. The maximal depth of necrosis was 2.4 mm, the maximal diameter 1.1 cm. There was no perforation found, even in critical areas like colon and duodenum. Accordingly argon beam coagulation was performed in 41 consecutive patients. The power and gas flow were varied in two stages between 40 and 75 watts and 2 and 3 l/min respectively. Coagulation time and angle of the probe were handled individually. In 32 of the 33 patients with bleeding from angiodysplastic lesions or polypectomy sites, with oozing of blood from erosions or ulcers or with bleeding due to vascular penetration by tumors definitive hemostasis was achieved in one to two sessions. In all of the four patients with residual sessile adenoma tissue complete removal was possible. Esophageal patency was restored in all four patients with stenosing tumors. In one patient with angiodysplasia of the cecal pole an asymptomatic accumulation of gas in the submucosa was observed which cleared spontaneously. In two patients with extensive esophageal carcinoma there was a transitory--also asymptomatic--accumulation of gas in the mediastinum and peritoneal cavity but no reference to perforation. The non-contact argon electrocoagulation is in gastrointestinal endoscopy an effective and non-expensive alternative to laser-technique.
透热凝固术在介入性内镜检查中不可或缺。氩离子束凝固术是一种创新的电凝方法，高频交流电通过电离氩气传导至组织，无需接触。在临床应用前，我们进行了体外研究，以评估胃、小肠和结肠新鲜切除标本的组织凝固深度和直径。功率和气体流量分别从40瓦至155瓦、2升/分钟至7升/分钟分五步递增。凝固时间（1秒至10秒）以及探头与组织表面的角度（45度、90度）有所变化。最大坏死深度为2.4毫米，最大直径为1.1厘米。即使在结肠和十二指肠等关键部位也未发现穿孔情况。相应地，对41例连续患者实施了氩离子束凝固术。功率和气体流量分两个阶段变化，分别为40瓦至75瓦以及2升/分钟至3升/分钟。凝固时间和探头角度分别进行处理。在33例因血管发育异常病变或息肉切除部位出血、糜烂或溃疡渗血或肿瘤穿透血管出血的患者中，32例在一至两个疗程内实现了确定性止血。在所有4例残留无蒂腺瘤组织的患者中均实现了完全切除。所有4例患有狭窄性肿瘤的患者食管通畅得以恢复。在1例盲肠极血管发育异常患者中，观察到黏膜下无症状性气体积聚，且自行消散。在2例广泛食管癌患者中，纵隔和腹腔出现了短暂性（同样无症状）气体积聚，但未提及穿孔情况。非接触式氩电凝术在胃肠内镜检查中是一种有效且成本低廉的激光技术替代方法。
