Chen C Y, Hsu N Y, Kwan P C, Hsu C P, Hsia J Y
Department of Surgery, Taichung Veterans General Hospital, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1996 Aug;58(2):79-83.
The mechanically incompetent lower esophageal sphincter (LES) plays a key role in patients with gastroesophageal reflux disease. The purpose of the study was to assess the pressure changes of LES in rabbits by intraabdominal injection of Teflon paste (Polytetrafluoroethylene) at the gastroesophageal junction.
New Zealand white breed of rabbits were used in these studies. The anesthetized rabbit was injected with a 21-gauge needle and a syringe loaded with Teflon paste. The injection sites were around the gastroesophageal junction. LES pressure was measured by conventional methods using a water-filled infused system. The pressure gradient was measured immediately before and after the injection as well as by a weekly measurement over four weeks. The histologic characteristics of the injection sites were studied four weeks later.
The mean pressure gradient of LES of twelve rabbits of immediate preinjection and post-injection was 29.71 +/- 8.10 mmHg and 37.58 +/- 10.69 mmHg (mean +/- S.D.), respectively (p value, 0.0329) Animals were followed upifor from one to four weeks, and were then sacrificed. The mean pressure gradient of LES of the twelve rabbits in the first week, the second week, the third week and the fourth week was 37.80 +/- 11.36 mmHG, 35.77 +/- 3.54 mmHg, 33.42 +/- 4.95 mmHg and 32.68 +/- 4.62 mmHg (mean +/- S.D.), respectively. Compared to pre-injection data, a significant difference was found in the first week and the second week (p value, 0.0342 and 0.0281, respectively). Gross examination of the gastroesophageal regions showed a welldefined Teflon mass of firm consistency at the site of the injection. Histological examination showed encapsulation of the implant by a thin layer of fibrous tissue and a benign foreign body granulomatous reaction with round cells surrounding the implant.
It is technically feasible to produce experimentally pressure changes of LES in rabbits by intraabdominal injection of Teflon paste. Nevertheless, the clinical validity on patients with gastroesophageal reflux induced by the incompetence of LES remains to be verified.
机械功能不全的食管下括约肌（LES）在胃食管反流病患者中起关键作用。本研究的目的是通过在胃食管交界处腹腔内注射聚四氟乙烯糊剂（聚四氟乙烯）来评估兔食管下括约肌的压力变化。
本研究使用新西兰白兔品种。将麻醉后的兔子用21号针头和装有聚四氟乙烯糊剂的注射器进行注射。注射部位在胃食管交界处周围。使用充满水的灌注系统通过传统方法测量LES压力。在注射前和注射后立即测量压力梯度，并在四周内每周测量一次。四周后研究注射部位的组织学特征。
12只兔子注射前和注射后即刻LES的平均压力梯度分别为29.71±8.10mmHg和37.58±10.69mmHg（平均值±标准差）（p值，0.0329）。动物随访1至4周，然后处死。12只兔子在第一周、第二周、第三周和第四周LES的平均压力梯度分别为37.80±11.36mmHg、35.77±3.54mmHg、33.42±4.95mmHg和32.68±4.62mmHg（平均值±标准差）。与注射前数据相比，在第一周和第二周发现有显著差异（p值分别为0.0342和0.0281）。胃食管区域的大体检查显示注射部位有明确的质地坚硬的聚四氟乙烯团块。组织学检查显示植入物被一层薄的纤维组织包裹，并伴有良性异物肉芽肿反应，植入物周围有圆形细胞。
通过腹腔内注射聚四氟乙烯糊剂在兔身上实验性地产生LES压力变化在技术上是可行的。然而，由LES功能不全引起的胃食管反流患者的临床有效性仍有待验证。
