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《消化内镜高频电技术临床应用专家共识》

2021-06-09 10:27:43

<section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">消化内镜治疗离不开高频电技术,从内镜下黏膜切除术(EMR)、内镜黏膜下剥离术(ESD)到衍生的隧道技术和复杂的NOTES手术,高频电技术贯穿始终。<br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">虽然消化内镜医师对高频电技术并不陌生,但在手术过程中也可能发生高频电相关的手术并发症,2020年7月,《中华消化内镜杂志》发布了《消化内镜高频电技术临床应用专家共识》。</section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">共识中涉及爱尔博相关技术,本文以此为基础,分享消化内镜高频电技术的临床应用。</section><section data-tools="新媒体排版" data-id="13784" data-style-type="标题" style="max-width: 100%; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin-top: 37.8px; margin-bottom: 37.8px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="color: rgb(0, 0, 0); max-width: 100%; width: 677px; height: 1px; background: -webkit-linear-gradient(left, rgb(231, 147, 255), rgb(141, 194, 255)); box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section><section style="max-width: 100%; display: flex; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="color: rgb(0, 0, 0); margin-top: 2.5px; max-width: 100%; float: left; width: 42px; height: 22px; background: -webkit-linear-gradient(left, rgb(231, 147, 255), rgb(141, 194, 255)); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; float: right; font-family: PingFangSC-Semibold; font-size: 16px; color: rgb(255, 255, 255); letter-spacing: 1.78px; line-height: 22px; min-width: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; min-width: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;">01</section></section></section><section style="margin-top: 3px; margin-left: 9px; max-width: 100%; text-align: center; height: 22px; line-height: 22px; font-family: PingFangSC-Semibold; z-index: 1; letter-spacing: 1.78px; font-size: 16px; font-weight: 700; min-width: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><seciton style="max-width: 100%; min-width: 16px; background-image: linear-gradient(135deg, rgb(247, 147, 255), rgb(141, 194, 255)); box-sizing: border-box !important; overflow-wrap: break-word !important;">基础技术部分</seciton></section></section></section></section><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">高频电技术是指由高频电源设备产生高频电流,高频电流通过电刀对人体组织产生热效应,不同的热效应对组织起到不同的效果。</section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">当输出为正弦波时为电切效应,即高频电流在接触部位瞬间产生大量热量,使细胞破裂、汽化,表现为组织分离;</section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">而输出为非正弦波时产生凝固效应,即高频电流在接触部位瞬间产生的热量较少,局部温度相对较低,使细胞失水干燥、蛋白质变性,表现为组织凝固。</section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section><section data-tools="新媒体排版" data-id="13784" data-style-type="标题" style="max-width: 100%; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin-top: 37.8px; margin-bottom: 37.8px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="color: rgb(0, 0, 0); max-width: 100%; width: 677px; height: 1px; background: -webkit-linear-gradient(left, rgb(231, 147, 255), rgb(141, 194, 255)); box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section><section style="max-width: 100%; display: flex; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="color: rgb(0, 0, 0); margin-top: 2.5px; max-width: 100%; float: left; width: 42px; height: 22px; background: -webkit-linear-gradient(left, rgb(231, 147, 255), rgb(141, 194, 255)); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; float: right; font-family: PingFangSC-Semibold; font-size: 16px; color: rgb(255, 255, 255); letter-spacing: 1.78px; line-height: 22px; min-width: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; min-width: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;">02</section></section></section><section style="margin-top: 3px; margin-left: 9px; max-width: 100%; text-align: center; height: 22px; line-height: 22px; font-family: PingFangSC-Semibold; z-index: 1; letter-spacing: 1.78px; font-size: 16px; font-weight: 700; min-width: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><seciton style="max-width: 100%; min-width: 16px; background-image: linear-gradient(135deg, rgb(247, 147, 255), rgb(141, 194, 255)); box-sizing: border-box !important; overflow-wrap: break-word !important;">高频电在经内镜逆行胰胆管造影术中的应用</seciton></section></section></section></section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">在ERCP术中进行EST时,与纯电切模式相比,采用混合模式可以减少术中出血风险及拉链式切开的发生率。<br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">Endocut模式与Blended模式均属于混合模式电流,两者的临床效果相当;发生术后胰腺炎的风险相似;但<strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">Endocut</strong><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">模式可以减少拉链式切开发生率及术中出血发生率</strong>。</section><section data-tools="新媒体排版" data-id="13784" data-style-type="标题" style="max-width: 100%; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin-top: 37.8px; margin-bottom: 37.8px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="color: rgb(0, 0, 0); max-width: 100%; width: 677px; height: 1px; background: -webkit-linear-gradient(left, rgb(231, 147, 255), rgb(141, 194, 255)); box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section><section style="max-width: 100%; display: flex; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="color: rgb(0, 0, 0); margin-top: 2.5px; max-width: 100%; float: left; width: 42px; height: 22px; background: -webkit-linear-gradient(left, rgb(231, 147, 255), rgb(141, 194, 255)); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; float: right; font-family: PingFangSC-Semibold; font-size: 16px; color: rgb(255, 255, 255); letter-spacing: 1.78px; line-height: 22px; min-width: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; min-width: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;">03</section></section></section><section style="margin-top: 3px; margin-left: 9px; max-width: 100%; text-align: center; height: 22px; line-height: 22px; font-family: PingFangSC-Semibold; z-index: 1; letter-spacing: 1.78px; font-size: 16px; font-weight: 700; min-width: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><seciton style="max-width: 100%; min-width: 16px; background-image: linear-gradient(135deg, rgb(247, 147, 255), rgb(141, 194, 255)); box-sizing: border-box !important; overflow-wrap: break-word !important;">高频电在内镜超声中的应用</seciton></section></section></section></section><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); text-indent: 28px; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">目前对于超声内镜引流的高频电使用缺乏高质量临床研究,综合专家建议:</p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); text-indent: 28px; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">①由于超声内镜引导下引流在进行切开过程中较少考虑穿孔风险,而术中可因出血导致引流失败,因此极少用单纯电切,更多采用混合模式,电凝的强度以不形成明显焦痂为宜;</p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); text-indent: 28px; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">②按10Fr电切环说明书所推荐的80-100W功率可以保证切开效率,但是当切开刀直径减小时(6F约为10Fr的40%,8.5Fr约为10Fr的70%),功率应该相应减低;</p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); text-indent: 28px; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">③<strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">Endocut</strong><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">电切模式中带电凝成分,引起出血风险较小,其中</strong><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">Endocut I</strong><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">模式适用于针状电切刀头的切开,</strong><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">EndocutQ</strong><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">模式适用于电切环的切开。</strong></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><section data-tools="新媒体排版" data-id="13784" data-style-type="标题" style="max-width: 100%; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin-top: 37.8px; margin-bottom: 37.8px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="color: rgb(0, 0, 0); max-width: 100%; width: 677px; height: 1px; background: -webkit-linear-gradient(left, rgb(231, 147, 255), rgb(141, 194, 255)); box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section><section style="max-width: 100%; display: flex; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="color: rgb(0, 0, 0); margin-top: 2.5px; max-width: 100%; float: left; width: 42px; height: 22px; background: -webkit-linear-gradient(left, rgb(231, 147, 255), rgb(141, 194, 255)); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; float: right; font-family: PingFangSC-Semibold; font-size: 16px; color: rgb(255, 255, 255); letter-spacing: 1.78px; line-height: 22px; min-width: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; min-width: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;">04</section></section></section><section style="margin-top: 3px; margin-left: 9px; max-width: 100%; text-align: center; height: 22px; line-height: 22px; font-family: PingFangSC-Semibold; z-index: 1; letter-spacing: 1.78px; font-size: 16px; font-weight: 700; min-width: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><seciton style="max-width: 100%; min-width: 16px; background-image: linear-gradient(135deg, rgb(247, 147, 255), rgb(141, 194, 255)); box-sizing: border-box !important; overflow-wrap: break-word !important;">高频电在胃肠道病变内镜治疗中的应用</seciton></section></section></section></section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">热圈套器切除术:</strong></section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">Endocut模式可根据组织不同的阻抗输出不同的功率,在使用热圈套器时可考虑使用Endocut Q模式,效果3。</section><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; background-color: rgb(255, 255, 255); text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><img src="http://www.sdwill.com/upload/news/20210609/efb786d548ad1e40d97d914515f0ee9d.png" alt="" style="width: 200px; height: 200px;"></p><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">氩等离子凝固术(</strong><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">APC</strong><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">):</strong></section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">有学者提出可使用氩气刀联合黏膜下注射,隔离黏膜肌层与固有肌层从而保护肠壁完整。APC在胃肠息肉的治疗中可作为辅助手段,有效地减少高频电切术后残余。</section><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; background-color: rgb(255, 255, 255); text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">内镜下黏膜切除术推荐意见:</strong></section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">内镜下息肉切除术应根据息肉的大小、形态、部位等综合判断,选择最佳的切除方式。</section><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">HSP与EMR中应避免使用纯电切电流,推荐使用混合模式,如EndocutQ模式。</p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">内镜黏膜下剥离术推荐意见:</strong></section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">可考虑在ESD中使用以下高频电参数,并根据应用后的实际情况进行调整:</section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">ESD标记采用强凝,效果2,25-30W。</section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">黏膜切开采用Endocut Q 3-2-4。</section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">黏膜下分离采用Endocut Q3-2-4或者Drycut,效果2-4,60-80W;或者快速电凝,效果2,40-50w。肌层采用Endocut Q 3-2-4。</section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">创面处理采用强力APC,1.0-1.8L/min,30W;或者止血钳,参数同血管处理。</section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">对于易形成狭窄的部位如食管、远端结直肠应尽量减少电凝的使用。</section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">对于十二指肠、直肠、右半结肠等消化道管壁较薄的部位,可适当降低功率及效果参数。</section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">对于小血管止血选用强凝模式(强凝,效果2-3,40-60W);</section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">对于较粗血管可使用止血钳夹住血管后轻柔后撤,选用软凝模式(止血钳,软凝,效果3-5,80-100W);</section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">对于较粗血管如不选用止血钳,可用低高频功率强凝(强凝,效果1,10 W)预凝止血后,再选择强凝(强凝,效果3,40-60W)切割血管。</section><section data-tools="新媒体排版" data-id="13784" data-style-type="标题" style="max-width: 100%; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin-top: 37.8px; margin-bottom: 37.8px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="color: rgb(0, 0, 0); max-width: 100%; width: 677px; height: 1px; background: -webkit-linear-gradient(left, rgb(231, 147, 255), rgb(141, 194, 255)); box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section><section style="max-width: 100%; display: flex; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="color: rgb(0, 0, 0); margin-top: 2.5px; max-width: 100%; float: left; width: 42px; height: 22px; background: -webkit-linear-gradient(left, rgb(231, 147, 255), rgb(141, 194, 255)); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; float: right; font-family: PingFangSC-Semibold; font-size: 16px; color: rgb(255, 255, 255); letter-spacing: 1.78px; line-height: 22px; min-width: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; min-width: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;">05</section></section></section><section style="margin-top: 3px; margin-left: 9px; max-width: 100%; text-align: center; height: 22px; line-height: 22px; font-family: PingFangSC-Semibold; z-index: 1; letter-spacing: 1.78px; font-size: 16px; font-weight: 700; min-width: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><seciton style="max-width: 100%; min-width: 16px; background-image: linear-gradient(135deg, rgb(247, 147, 255), rgb(141, 194, 255)); box-sizing: border-box !important; overflow-wrap: break-word !important;">参考文献</seciton></section></section></section></section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">柏愚,杨帆,刘翠,等.消化内镜高频电技术临床应用专家共识(2020,上海)[J].中华消化内镜杂志,2020,37(7):457-465.<br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section><section style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section><p style="margin-bottom: 0px; margin-left: 14px; max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><section data-tools="新媒体排版" data-id="9190" data-style-type="undefined" style="max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><p style="margin-bottom: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; text-align: center; overflow-wrap: break-word !important;">◆&nbsp;◆&nbsp;◆&nbsp;◆&nbsp;◆</p></section><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; text-align: justify; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img src="../../upload/news/20210609/68b6483e19f5797d16eaa54511ebdd2b.png"></p><p style="text-align: left; margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.621714px; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img src="../../upload/news/20210609/a3d381c0704d7a0e0ed632e58aba4a91.png"></p><p style="margin-bottom: 0px; 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