Wahab P J, Mulder C J, den Hartog G, Thies J E
Dept. of Hepatogastroenterology, Rijnstate Hospital, Arnhem, The Netherlands.
Endoscopy. 1997 Mar;29(3):176-81. doi: 10.1055/s-2007-1004159.
In argon plasma coagulation (APC), high-frequency energy is transmitted to tissue by ionized gas, thus reducing contact with the tissue to a minimum. Successful endoscopic APC was initially reported in the palliative treatment of gastrointestinal neoplasms. The main objectives in this pilot study were to evaluate the treatment indications, efficacy and safety of the use of APC.
Between September 1994 and January 1996, APC was used to treat 125 patients with various forms of gastrointestinal pathology.
For local palliative treatment, APC was successfully used alongside snare loop coagulation, dilation, stenting and/or radiotherapy to treat the following conditions: carcinoma of the esophagus: 15 patients, mean number of treatment sessions (MTS) 3.3; gastric carcinoma: 10 patients, MTS 4.9; rectosigmoid carcinoma: seven patients, MTS 2.7; carcinoma of the papilla of Vater: two patients, MTS 1.5. Repeated treatment was also effective for tubulovillous adenoma of the rectum (20 patients, MTS 2.5), stomach (three patients, MTS 2.0), duodenum (two patients, MTS 1.5) and papilla of Vater (two patients, MTS 3.0). In addition, APC proved helpful in coagulating the remaining tissue and achieving hemostasis after polypectomy in the colon (18 patients, MTS 1.2) and in endoscopic treatment of Zenker's diverticulum, for coagulation of the tissue bridge and hemostasis (31 patients, MTS 2.5). Finally, APC was helpful in coagulation of multiple gastric polyps (one patient, one session), hemostasis in superficial ulceration of the duodenal bulb (one patient, one session), after dilation of benign stenoses of anastomoses in the esophagus (one patient, one session) and colon (one patient, one session) and for vascular malformations in the colon (three patients, MTS 1.3), duodenum (one patient, one session), antrum (one patient, two sessions), and watermelon stomach (six patients, MTS 2.8). We recognized signs of perforation in six patients after treatment of Zenker's diverticulum (n = 3), polypectomy in the colon (n = 2) and coagulation of angiodysplasia in the cecum. Laparotomy was carried out in two patients; in one, a perforation was sutured, and in the other no focus of leakage was seen. All six patients recovered without further complications. No complications were observed in any other patients.
These initial experiences indicate that APC seems to be effective in a number of indications, and relatively safe. Objective evaluation, a longer follow-up period, and comparative trials with other treatment modalities should follow.
在氩离子凝固术（APC）中，高频能量通过电离气体传输至组织，从而将与组织的接触降至最低。内镜下APC治疗胃肠道肿瘤的姑息治疗最初已有报道。本初步研究的主要目的是评估APC的治疗适应证、疗效及安全性。
1994年9月至1996年1月期间，采用APC治疗125例患有各种形式胃肠道病变的患者。
对于局部姑息治疗，APC与圈套器电凝、扩张、支架置入和/或放射治疗联合成功用于治疗以下疾病：食管癌：15例患者，平均治疗次数（MTS）为3.3次；胃癌：10例患者，MTS为4.9次；直肠乙状结肠癌：7例患者，MTS为2.7次； Vater壶腹癌：2例患者，MTS为1.5次。重复治疗对直肠（20例患者，MTS为2.5次）、胃（3例患者，MTS为2.0次）、十二指肠（2例患者，MTS为1.5次）和Vater壶腹（2例患者，MTS为3.0次）的管状绒毛状腺瘤也有效。此外，APC在结肠息肉切除术后（18例患者，MTS为1.2次）用于凝固残留组织并实现止血，以及在内镜治疗Zenker憩室时用于凝固组织桥并止血（31例患者，MTS为2.5次）也有帮助。最后，APC在凝固多个胃息肉（1例患者，1次治疗）、十二指肠球部浅表溃疡止血（1例患者，1次治疗）、食管（1例患者，1次治疗）和结肠（1例患者，1次治疗）吻合口良性狭窄扩张后，以及结肠（3例患者，MTS为1.3次）、十二指肠（1例患者，1次治疗）、胃窦（1例患者，2次治疗）和西瓜胃（6例患者，MTS为2.8次）的血管畸形治疗中也有帮助。我们在治疗Zenker憩室（n = 3）、结肠息肉切除术后（n = 2）和盲肠血管发育异常凝固后，发现6例患者有穿孔迹象。2例患者接受了剖腹手术；其中1例缝合了穿孔，另1例未发现渗漏部位。所有6例患者均康复，无进一步并发症。其他患者未观察到并发症。
这些初步经验表明，APC在多种适应证中似乎有效且相对安全。应进行客观评估、更长的随访期以及与其他治疗方式的对比试验。
