應用豬小腸粘膜下層預防內(nèi)鏡粘膜下剝離術(shù)后食管狹窄的動物研究
發(fā)布時間：2018-10-12 19:38
【摘要】：研究背景內(nèi)鏡黏膜下剝離術(shù)(endoscopic submucosal dissection,ESD)是早期食管癌有效的治療方法。但ESD術(shù)可能會造成嚴重的食管狹窄,影響患者的預后及生活治療。小腸黏膜下層(small intestinal submucosa,SIS)是一種理想細胞外基質(zhì)(extracellular matrix,ECM)材料,其具有高組織相容性及生物力學性能,安全性高。目的探討豬小腸細胞外基質(zhì)預防ESD術(shù)后狹窄的功效。方法選取9只雜交豬在插管麻醉后行環(huán)周食管ESD術(shù)。其中3只在內(nèi)鏡下用支架將小腸細胞外基質(zhì)放置到食管ESD術(shù)后食管損傷位置為小腸粘膜下層組,3只在創(chuàng)面放置支架為支架組,另外3只為空白對照組。在第2周及第4周復查胃鏡觀察食管狹窄情況,在第8周進行病理學評價。結(jié)果通過十二烷基硫酸鈉脫細胞法和酶消化方法后,蘇木精-伊紅染色法(hematoxylin and eosin stain)檢測發(fā)現(xiàn)脫細胞成功,從而制備了具有組織相容性的豬小腸細胞外基質(zhì)。9只雜交豬接受環(huán)周食管ESD術(shù)后,支架組及空白對照組的6只豬在術(shù)后2周發(fā)生了不同程度的粘膜狹窄,其中3只因不能耐受經(jīng)口進食,而進行了早期安樂死。2周及4周性內(nèi)鏡檢查,可見支架組及空白對照組ESD術(shù)后創(chuàng)面出現(xiàn)持續(xù)的炎癥反應及不完全的上皮形成。豬小腸黏膜下層組行2周及4周性內(nèi)鏡檢查,發(fā)現(xiàn)ESD術(shù)后創(chuàng)面炎癥反應少,能逐漸形成上皮組織,食管狹窄程度較支架組及空白對照組低。4周時病理標本顯示,豬小腸黏膜下層組的標本粘膜炎癥反應少,狹窄程度較支架組及空白對照組低。結(jié)論本研究成功制備具有生物相容性的豬小腸細胞外基質(zhì),將其放置在豬食管環(huán)周ESD術(shù)后的創(chuàng)面,有效預防了食管狹窄的發(fā)生。通過本研究將有助于為臨床預防ESD術(shù)后食管狹窄提供新思路,并為組織工程生物材料的制備及臨床應用夯實基礎。
[Abstract]:Background Endoscopic submucosal dissection (endoscopic submucosal dissection,ESD) is an effective treatment for early esophageal cancer. However, ESD may cause severe esophageal stenosis, affecting the prognosis of patients and life treatment. Small intestinal submucosal (small intestinal submucosa,SIS is an ideal extracellular matrix (extracellular matrix,ECM) material with high histocompatibility, biomechanical properties and high safety. Objective to investigate the effect of extracellular matrix (ECM) of porcine small intestine on prevention of stenosis after ESD. Methods Nine crossbred pigs were treated with circumferential esophageal ESD after intubation anesthesia. Three of them were placed in the submucous layer of small intestine group, three of them were stents on the wound surface, and the other three were the blank control group, when the extracellular matrix of small intestine was placed in the esophageal submucosa group after esophageal ESD operation. Esophageal stenosis was observed by gastroscopy at week 2 and week 4, and pathological evaluation was performed at week 8. Results after decellularization of sodium dodecyl sulfate and enzyme digestion, (hematoxylin and eosin stain) detection of hematoxylin and eosin staining showed that acellular cells were successfully removed. The extracellular matrix of pig small intestine with histocompatibility was prepared. Nine crossbred pigs received circumferential esophageal ESD. Six pigs in the stent group and the blank control group suffered from mucosal stenosis in different degrees at 2 weeks after operation. Three of them underwent early euthanasia because they could not tolerate oral feeding. 2 and 4 weeks of endoscopic examination showed persistent inflammatory reaction and incomplete epithelium formation in the wounds after ESD in the stent group and the blank control group. After 2 and 4 weeks of endoscopic examination in the porcine intestinal submucosa group, it was found that the inflammatory reaction of the wound surface after ESD was less and the epithelial tissue was gradually formed. The degree of esophageal stenosis was lower than that in the stent group and the blank control group. The mucosal inflammation in the submucosal group was less and the degree of stenosis was lower than that in the stent group and blank control group. Conclusion in this study, the biocompatible extracellular matrix of porcine small intestine was successfully prepared and placed in the wound of porcine periesophageal circumferential ESD, which effectively prevented the occurrence of esophageal stenosis. This study will provide a new idea for clinical prevention of esophageal stenosis after ESD and lay a solid foundation for the preparation and clinical application of tissue engineering biomaterials.
【學位授予單位】：首都醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.1
本文編號：2267353
[Abstract]:Background Endoscopic submucosal dissection (endoscopic submucosal dissection,ESD) is an effective treatment for early esophageal cancer. However, ESD may cause severe esophageal stenosis, affecting the prognosis of patients and life treatment. Small intestinal submucosal (small intestinal submucosa,SIS is an ideal extracellular matrix (extracellular matrix,ECM) material with high histocompatibility, biomechanical properties and high safety. Objective to investigate the effect of extracellular matrix (ECM) of porcine small intestine on prevention of stenosis after ESD. Methods Nine crossbred pigs were treated with circumferential esophageal ESD after intubation anesthesia. Three of them were placed in the submucous layer of small intestine group, three of them were stents on the wound surface, and the other three were the blank control group, when the extracellular matrix of small intestine was placed in the esophageal submucosa group after esophageal ESD operation. Esophageal stenosis was observed by gastroscopy at week 2 and week 4, and pathological evaluation was performed at week 8. Results after decellularization of sodium dodecyl sulfate and enzyme digestion, (hematoxylin and eosin stain) detection of hematoxylin and eosin staining showed that acellular cells were successfully removed. The extracellular matrix of pig small intestine with histocompatibility was prepared. Nine crossbred pigs received circumferential esophageal ESD. Six pigs in the stent group and the blank control group suffered from mucosal stenosis in different degrees at 2 weeks after operation. Three of them underwent early euthanasia because they could not tolerate oral feeding. 2 and 4 weeks of endoscopic examination showed persistent inflammatory reaction and incomplete epithelium formation in the wounds after ESD in the stent group and the blank control group. After 2 and 4 weeks of endoscopic examination in the porcine intestinal submucosa group, it was found that the inflammatory reaction of the wound surface after ESD was less and the epithelial tissue was gradually formed. The degree of esophageal stenosis was lower than that in the stent group and the blank control group. The mucosal inflammation in the submucosal group was less and the degree of stenosis was lower than that in the stent group and blank control group. Conclusion in this study, the biocompatible extracellular matrix of porcine small intestine was successfully prepared and placed in the wound of porcine periesophageal circumferential ESD, which effectively prevented the occurrence of esophageal stenosis. This study will provide a new idea for clinical prevention of esophageal stenosis after ESD and lay a solid foundation for the preparation and clinical application of tissue engineering biomaterials.
【學位授予單位】：首都醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.1
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