2000年以来,フィブリン接着剤(FG)の局注による内視鏡的止血を検討してきたが,クリッピング,エタノール(E)局注の実施し難い上部消化管の止血に対して満足しうる結果が得られた.これまで上部消化管の潰瘍性出血に対するFG局注による内視鏡的止血についてはかなりの報告がみられるが,多くは臨床例についての報告であり,その病理組織学的検討についての報告は殆ど見当たらない.ここではラットを用いて,実験的に上部消化管の潰瘍性出血を作製し,これに対するFG局注の効果と有効性について病理組織学的にE局注と比較しながら検討した.S-Dラットをエーテル麻酔下に開腹し,胃切開の後,胃幽門前庭部に機械的に出血性潰瘍を作製した.FGあるいはEを潰瘍部に局注した後,外科創を縫合した.その1,3,あるいは5日後に胃を摘出し病理組織学的に検討した.E群ではcontrol群(生理食塩水局注)と比較して止血効果を確認したが,組織傷害は増強し,炎症細胞の浸潤が局注後数日間増加する像がみられた.FG群の止血効果はE群とほぼ同等であったが,組織傷害は限られた徴候がみられたのみで,E群よりも軽度であった.E群では胃壁の穿孔例がみられたが,FG群およびcontrol群では穿孔例はなかった.E群と比較してFG群は組織刺激性ないし傷害が少なく,潰瘍を増悪することもなく,組織に長時間停留して作用が持続的であった.以上よりFG局注は有効な止血法であり,上記利点をもつ内視鏡的止血法として加えうるものと考える.Since 2000, we have been conducting studies on endoscopic hemostasis with local injection of fibrin glue (FG). The procedure has produced satisfactory results in treating patients with hemorrhage of the upper digestive tract who were difficult to treat with more conventional method, such as clipping or ethanol injection. There have been no reports on the histopathological effects of FG. In this study, the effects and efficacy of locally injected FG were investigated by using rats and the result was compared with the effects of ethanol (E). Sprague-Dawley rats were subjected to a laparotomy under ether anesthesia, followed by mechanical creation of a hemorrhagic ulcer at the pyloric vestibulum. In group E, in comparison with the control group, a hemostatic effect was recognized; but tissue damage was intensified and infiltration by inflammatory cells increased during the several days following the procedure. In group FG, the hemostatic effect was almost comparable to that of group E and there were only limited signs of tissue damage, which were much milder than in group E. In the latter group, the development of a postoperative perforation was observed, whereas no animals in the sham or group FG experienced similar conditions. Compared with E, local injection of FG may be a practical procedure for endoscopic hemostasis
