摘要目的：评价内镜黏膜下剥离术（ESD）术中黏膜下注射肾上腺素生理盐水的安全性和有效性，并探讨其最佳浓度。方法128例上消化道疾病患者按入组先后顺序采用数字表法随机均分成4组，A 组使用生理盐水作为黏膜下注射液，B 组、C 组和 D 组则分别使用浓度为0．001％、0．002％和0．004％的肾上腺素生理盐水。记录各组 ESD 手术完成情况、患者血压及心率变化情况、并发症发生情况、黏膜下注射液用量、手术时间，并行组间或组内对比分析。结果各组均能顺利完成手术，组内术前与术中比较最高血压及最快心率差异均无统计学意义（P ＞0．05），无一例出现穿孔及术中急性大量出血。术中急性少量出血发生率，A 组（28．1％，9／32）明显高于 B 组（9．4％，3／32）、C 组（6．3％，2／32）和D 组（6．3％，2／32），差异均有统计学意义（P ＜0．05），而 B 组、C 组、D 组间差异均无统计学意义（P ＞0．05）。各组间术后迟发性出血发生率比较差异均无统计学意义（P ＞0．05）。黏膜下注射液用量，A 组为（39．5±10．8）ml，明显高于 B 组的（29．4±9．4）ml、C 组的（27．3±8．2）ml 和 D 组的（20．4±11．8）ml，差异均有统计学意义（P ＜0．05），而 B 组、C 组、D 组间差异均无统计学意义（P ＞0．05），但 D 组较 B 组有减少趋势。手术时间，A 组为（82．3±24．78）min，明显长于 B 组的（60．7±25．35）min、C 组的（54．7± 31．72）min 和 D 组的（59．2±28．49）min，差异均有统计学意义（P ＜0．05），而 B 组、C 组、D 组间差异均无统计学意义（P ＞0．05）。结论ESD 术中黏膜下注射肾上腺素生理盐水安全有效，可减少注射液用量，缩短手术时间，减少术中出血的发生，但增加肾上腺素浓度未能发现明显优势。

abstractsObjective To evalute and compare the efficacy and safety of epinephrine-saline submu-cosal injection of different concentrations on endoscopic submucosal dissection (ESD),and to discuss the best concentration of submucosal injection.Methods A total of 128 patients who underwent ESD were ran-domly assigned to submucosal normal saline injection group (group A,n =32),0.001% epinephrine-saline injection group (group B,n =32),0.002% epinephrine-saline injection group (group C,n =32),and 0.004% epinephrine-saline injection group (group D,n =32).The incidence of bleeding during and after ESD were counted,the blood preasure and heart rate of preoperative and intraoperative,the amount of sub-mucosal injection,the time of operation were observed.Results ESD was successfully performed on all pa-tients.There were no difference in highest blood preasure and fastest heart rate between preoperative and in-traoperative results of each group.No perforation or intraoperative acute massive bleeding occurred.Intraop-erative acute minimal bleeding during ESD occurred in 9 patients in group A and 3 in group B,2 in group C and 2 in group D (P <0.05),but there were no differences among group B,C and D.The amount of submu-cosal injection of group A was(39.5 ±10.8)ml,which was more than that of group B(29.4 ±9.4)ml,group C(27.3 ±8.2)ml and group D(20.4 ±11.8)ml with significant difference.There were no differences a-mong group B,C and D,but there was less in group D than group B.The operation time of group A was(82.3 ±24.78 minutes),which was longer than that of group B (60.7 ±25.35minutes),group C (54.7 ± 31.72minutes)and group D(59.2 ±28.49 minutes),but there was no difference among B,C and D group. Conclusion Epinephrine-saline submucosal injection assiting ESD is safe and effective and reduces the op-eration time and bleeding than normal saline.The increase of the epinephrine-saline concentrations has not been found to be more beneficial.