消化
词汇介绍
拓展阅读
解析
argon 英 [ˈɑːɡɒn] 美 [ˈɑːrɡɑːn]
释义 n. [化学] 氩(18号元素)
例句 The effect of nitrogen can be overcome by sheathing the flame in argon. 氮的影响则可以通过用氩气包覆火焰而予以克服。
plasma 英 [ˈplæzmə] 美 [ˈplæzmə]
释义 n. [等离子] 等离子体;血浆;[矿物] 深绿玉髓
例句 One Plasma to bind them. 等离子把他们联系在一起。
coagulation 英 [kəʊ,æɡjʊ'leɪʃən] 美 [koʊˌæɡjuˈleɪʃn]
释义 n. 凝固,凝结;凝结物
例句 The ultrafiltration rate of pure water with the coagulation bath temperature increased. 纯水的超滤率随凝固浴温度的升高而增大
概述
概述
氩离子凝固术(argon plasma coagulation,APC)是一种非接触性电凝固技术,其原理是利用特殊装置将氩气离子化,氩气通过离子化传导由钨丝电极产生的高频电能,继而能量被传导至组织而产生凝固效应。APC装置由一个高频电能发生器,一个氩气源及探头(内径1.5mm,外径2.0mm),一根远端陶瓷管口内装有钨丝电极的可屈式纤维Teflon管组成,此管可以通过内镜的钳道。
适应症
(1)食管疾病,包括Barrett's食管、晚期食管癌恶性狭窄、食管内支架置入后网眼和支架上下端再狭窄等;
(2)胃肠道出血,包括消化性溃疡出血、血管畸形、癌性溃烂出血等;
(3)胃肠道息肉,尤其适合于扁平、广基且直径≤1.5cm的息肉;
(4)胃肠道早期肿瘤,尤其是小灶性早期及无法手术切除者作姑息性治疗;
(5)其他适应证包括Dieulafoy氏溃疡、疣状胃炎等。
禁忌症
(1)大出血伴有休克,或消化道积满血液影响视野时;
(2)食管及(或)胃底静脉出血、Mallory-Weiss综合征引起的广泛出血;
(3)合并急性或慢性心肌缺血、严重心律失常、严重肺部疾病、出血性疾病、其他严重的全身性疾病及不合作者。
操作步骤
(1)术前首先打开氩离子凝固器的氩气钢瓶阀门,注满氩气;
(2)体外预试验;
(3)将中性电极板固定于病人肌肉丰富的地方,如病人的大小腿、臀部等,并使其充分接触。准确连接手控柄、脚踏板及附件;
(4)设定合适的气体流量、功率。一般设置为氩气流量2.4L·min-1,功率60W,电凝指数A60(专为氩离子凝固术配设);
(5)在电子内镜和电子肠镜直视下,先近镜观察病灶,然后经内镜钳道插入氩离子凝固器导管,导管伸出内镜头端,直至病灶上方约0.3cm~0.5cm处,与组织角度为30~60°,以每次1s~3s的时间施以氩离子凝固治疗。
并发症
(1)穿孔,为APC主要并发症;
(2)胃肠胀气;
(3)局部炎性肉芽肿形成;
(4)其他 治疗食管疾病时可发生吞咽痛、咽下困难、食管狭窄、食管出血、胸骨后疼痛及发热等。
优点
(1)有效安全;
(2)非接触性使用,避免了因接触治疗而引起的探头粘连;
(3)有限的凝固深度,一般为0.5-3.0MM(为高频电刀的1/3),不易发生穿孔;
(4)大面积迅速止血,减少操作时间;
(5)氩气电弧均匀、细密,形成的结痂也均匀牢固;
(6)对金属支架无破坏作用;
(7)较少的烟雾,良好视野;
(8)装置轻便,易操作。
Barrett食管高度异型增生或T1期腺癌内镜切除术后射频消融与氩等离子凝固的比较: 一项随机初步研究 (BRIDE)
发表时间:2019-04-25
影响指数:7.2
作者: Mohammad Farhad Peerally
期刊:Gastrointestinal Endoscopy
The most important element of endoscopic therapy is endoscopic resection (ER), which targets macroscopically visible lesions, providing accurate staging information6,7 and successful management.8,9 However, ER targets only visible abnormalities, leaving BE in which dysplasia could recur.10 Metachronous dysplasia occurs in up to 30% of residual BE after ER10 but not if all BE is removed by stepwise repeated ER, although esophageal stenosis is frequent (>80% in a recent randomized trial [RCT]).11 Ablative techniques, including thermal methods such as argon plasma coagulation (APC)12-14 and radiofrequency ablation (RFA)15,16 offer an alternative strategy. Both are effective in case series and RCTs, with the strongest evidence for RFA. Shaheen et al,17 in a multicenter RCT comparing RFA with sham, found dysplasia clearance at 1 year of 81% in patients with HGD. Large prospective series have shown similar results.18-20 Efficacy of APC in clearance of dysplastic and nondysplastic BE has been demonstrated in small case series12-14,21,22 and recently in an RCT comparing APC with surveillance of residual BE after ER for HGD or intramucosal cancer: metachronous lesions occurred in 3% after APC compared with 36% after 24 months’ surveillance.23 RFA has been more extensively investigated17,20,24,25and has a standardized methodology developed from in vitro and animal studies,26 allowing a predictable burn depth,27 and extensive clinical experience from U.K. and U.S. registries has shown a good safety profile.18,19,28,29 APC is cheaper and widely available but is less standardized.
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