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Quantitative evaluation of the safety of mucosal incision and submucosal dissection for colon during endoscopic submucosal dissection using carbon dioxide laser

机译:二氧化碳激光内镜黏膜下剥离术对结肠黏膜切口和黏膜下剥离术安全性的定量评估

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Since the increase in the overall mortality rate in patients with colon cancer is remarkably high in recent years, early treatment is required. For this reason, endoscopic submucosal dissection (ESD) has been at the forefront of international attention as a low invasive treatment for early digestive cancer. In current ESD procedure, an electrosurgical knife is used for mucosal incision and subsequent submucosal dissection. However, the perforation has been reported to occur by approximately 5%. Thus, to enhance the tissue selectivity of this modality, we focused on the application of laser for ESD. A carbon dioxide laser was chosen as a surgical knife because the saline or a sodium hyaluronate solution injected into the submucosal layer in current ESD procedure has a high absorption coefficient at the wavelength of the carbon dioxide laser. In this research, ex vivo experiment was performed at the output power of 3-7 W and discuss the optimum irradiation power of laser. As a result of ex vivo experiment using extracted porcine colon tissues, mucosal incision and submucosal dissection were safely and less invasively performed in every output power, without reaching the thermal damage to a muscular layer. This is because a carbon dioxide laser is strongly absorbed by saline injected into submucosa. ESD using a carbon dioxide laser is a safer method for the treatment of early colon cancer. We are planning to measure and compare the optical and thermal properties of porcine colon with those of human colon.
机译:由于近年来结肠癌患者的总死亡率增加非常高,因此需要早期治疗。因此,内镜下粘膜下剥离术(ESD)作为早期消化道癌的低侵入性治疗方法已成为国际关注的焦点。在当前的ESD程序中,使用电外科刀进行粘膜切口和随后的粘膜下剥离。但是,据报道穿孔发生了大约5%。因此,为了提高该模式的组织选择性,我们集中于激光用于ESD的应用。选择二氧化碳激光器作为手术刀是因为在当前ESD程序中注入粘膜下层的盐水或透明质酸钠溶液在二氧化碳激光器的波长处具有高吸收系数。在这项研究中,在3-7 W的输出功率下进行了离体实验,并讨论了激光的最佳照射功率。使用提取的猪结肠组织进行的离体实验的结果是,在每种输出功率下均安全且侵入性较小地进行了粘膜切口和粘膜下剥离,而没有达到对肌肉层的热损伤。这是因为二氧化碳激光被注入粘膜下层的盐水强烈吸收。使用二氧化碳激光的ESD是治疗早期结肠癌的一种较安全的方法。我们计划测量和比较猪结肠和人类结肠的光学和热学性质。

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