本文選題：內(nèi)鏡黏膜下剝離術(shù)(ESD)　切入點(diǎn)：羧甲基纖維素膜(CMC)　出處：《第二軍醫(yī)大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：研究目的:探討羧甲基纖維素膜預(yù)防食管環(huán)周型ESD術(shù)后狹窄的有效性及相關(guān)可能機(jī)制。研究方法:本實(shí)驗(yàn)分為兩部分。第一部分為動(dòng)物實(shí)驗(yàn)。將14只巴馬豬分為兩組,分別為CMC組(n=7)和對(duì)照組(n=7)。通過(guò)術(shù)前健康觀察和禁食后,在全麻狀態(tài)下,于食管40-45cm段長(zhǎng)約5cm處行食管環(huán)周ESD手術(shù)。CMC組術(shù)后立即在創(chuàng)面放置CMC膜,對(duì)照組創(chuàng)面則不予處理,兩組實(shí)驗(yàn)動(dòng)物均于術(shù)后14天處死。術(shù)后分別觀察記錄兩組動(dòng)物的體重變化、吞咽困難評(píng)分、內(nèi)鏡復(fù)查結(jié)果以及對(duì)處死后所獲取的創(chuàng)面組織進(jìn)行的狹窄數(shù)據(jù)的測(cè)量。第二部分為基礎(chǔ)實(shí)驗(yàn)研究。對(duì)術(shù)后14天獲取的食管創(chuàng)面組織進(jìn)行組織病理學(xué)檢測(cè),通過(guò)HE染色、Masson染色對(duì)比分析兩組間的固有肌層損傷、黏膜下層纖維化程度和上皮再生情況。使用Elisa方法分別檢測(cè)術(shù)前0天和術(shù)后14天動(dòng)物血清中TGF-β1、TNF-α、IL-1β、IL-6的含量。通過(guò)實(shí)時(shí)熒光定量PCR和Western blot分別檢測(cè)術(shù)后7天食管創(chuàng)面愈合組織中TGF-β1、CTGF、α-sma的mRNA和蛋白表達(dá)水平。結(jié)果:第一部分結(jié)果:兩組體重在術(shù)后14天均下降,但CMC組體重減少百分比(3.09±1.63)%與對(duì)照組體重減少百分比(4.97±3.40)%之間無(wú)統(tǒng)計(jì)學(xué)差異,p=0.220。術(shù)后7天,CMC組吞咽困難指數(shù)為(1.1±0.7)低于對(duì)照組(2.0±0.8),但差別無(wú)統(tǒng)計(jì)學(xué)意義,p=0.055;術(shù)后14天,CMC組吞咽困難指數(shù)為(2.3±0.8)低于對(duì)照組(3.3±0.8),差別有統(tǒng)計(jì)學(xué)意義,p=0.029。內(nèi)鏡下術(shù)后14天,兩組動(dòng)物食管均狹窄,但CMC組創(chuàng)面愈合情況好于對(duì)照組。經(jīng)過(guò)大體標(biāo)本測(cè)量,CMC組食管黏膜狹窄率為(53.0±5.6)%低于對(duì)照組(72.1±4.0)%,兩組間有統(tǒng)計(jì)學(xué)意義,p㩳0.05。第二部分結(jié)果:通過(guò)組織病理學(xué)檢測(cè),CMC組新生上皮長(zhǎng)度為(7.21±0.86)mm長(zhǎng)于對(duì)照組(5.30±1.25)mm,差異有統(tǒng)計(jì)學(xué)意義,p=0.006;CMC組食管黏膜下層纖維化厚度為(1.01±0.24)mm要低于對(duì)照組(1.54±0.21)mm,差異有統(tǒng)計(jì)學(xué)意義,p=0.001;固有肌層損傷程度評(píng)分CMC組中位數(shù)為1(range 0-2)低于對(duì)照組中位數(shù)2(range2-3),且具有統(tǒng)計(jì)學(xué)意義,p=0.016。術(shù)后14天TGF-β1因子水平,CMC組(3285.71±531.61)要低于對(duì)照組(4593.71±771.03),p=0.003;且兩組術(shù)前術(shù)后TGF-β1因子差值也有統(tǒng)計(jì)學(xué)差異,p=0.021;而另外三個(gè)因子TNF-α、IL-1β、IL-6兩組間對(duì)比均無(wú)顯著差異。通過(guò)實(shí)時(shí)熒光定量PCR和Western blot檢測(cè),CMC組與對(duì)照組相比,食管創(chuàng)面組織TGF-β1、CTGF、α-sma的mRNA和蛋白表達(dá)水平均下降,且均具有統(tǒng)計(jì)學(xué)差異,p0.05。結(jié)論:內(nèi)鏡下放置CMC膜于食管環(huán)周ESD術(shù)后創(chuàng)面,可以有效減輕術(shù)后豬食管狹窄進(jìn)程,為預(yù)防食管環(huán)周ESD術(shù)后狹窄提供了新的策略。
[Abstract]:Objective: to investigate the effectiveness of carboxymethylcellulose membrane in preventing esophageal circumferential ESD stenosis and its possible mechanism. Methods: the experiment was divided into two parts. The first part was animal experiment. Fourteen Bama pigs were divided into two groups. CMC group (n = 7) and control group (n = 7). After health observation and fasting before operation, under general anesthesia, CMC membrane was placed on the wound in the esophageal circumferential ESD group at a length of about 5 cm between 40 cm and 45 cm after general anesthesia, while the wound in the control group was not treated. The experimental animals in both groups were killed on the 14th day after operation. The weight changes and dysphagia scores of the two groups were observed and recorded respectively after operation. The results of endoscopic reexamination and the measurement of stricture data of wound tissue obtained after death. The second part is a basic experimental study. Histopathological examination of esophageal wound tissue acquired 14 days after operation was carried out. The injury of the lamina propria muscularis between the two groups was analyzed by HE staining and Masson staining. The degree of submucosal fibrosis and epithelial regeneration were measured by Elisa method. The serum TGF- 尾 1 and TNF- 偽 TNF- 偽 IL-1 尾 -IL-6 were measured by Elisa method. The recovery of esophageal wound was detected by real-time fluorescence quantitative PCR and Western blot. The expression of mRNA and protein in TGF- 尾 1 CTGF, 偽 -sma was observed. Results: the first part: the body weight of the two groups decreased 14 days after operation. However, there was no significant difference in weight loss percentage between CMC group and control group by 3.09 鹵1.63% and 4.97 鹵3.40% respectively. The dysphagia index of CMC group was 1.1 鹵0.7 on the 7th day after operation, which was lower than that of control group (2.0 鹵0.8), but the difference was not statistically significant, and 14 days after operation, the dysphagia index of CMC group was lower than that of control group, but the difference was not statistically significant, and 14 days after operation, the dysphagia index of CMC group was lower than that of control group. The difficulty index was 2.3 鹵0.8), which was significantly lower than that in the control group (3.3 鹵0.8). The rate of esophageal mucosal stenosis in the CMC group was 53.0 鹵5.6% lower than that in the control group (72.1 鹵4.0%), and there was significant difference between the two groups. Results of the second part: the length of neonate epithelium in CMC group was 7.21 鹵0.86 mm longer than that in control group (5.30 鹵1.25 mm), and the thickness of submucosal fibrosis in CMC group was 1.01 鹵0.24 mm lower than that in control group (1.54 鹵0.21 mm). The median of myometrium injury in the CMC group was lower than that in the control group (1 range 0-2), which was significantly lower than that in the control group (P 0.016). The level of TGF- 尾 1 factor in the CMC group was 3285.71 鹵531.61on the 14th day after operation, which was lower than that in the control group (4593.71 鹵771.03p0.003), and the difference of TGF- 尾 1 factor between the two groups before and after operation was also lower than that in the control group. There were significant differences between the two groups, but there was no significant difference between the three other factors, TNF- 偽, IL-1 尾 and IL-6. The results of real-time fluorescence quantitative PCR and Western blot were compared with those of the control group. The expression levels of mRNA and protein of TGF- 尾 1 CTGF and 偽 -sma in esophageal wound tissue were all decreased, and the difference was statistically significant (P 0.05). Conclusion: placing CMC membrane into the wound surface of esophageal circumferential ESD under endoscope can effectively alleviate the process of esophageal stricture after operation. It provides a new strategy to prevent the stricture of periesophageal ESD.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R735.1

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