经胃内镜下胃空肠旁路技术在动物模型的研究

发布时间：2018-10-18 12:10

【摘要】：背景：胃空肠旁路手术用于胃输出道恶性梗阻、胰十二指肠旷置及减容手术患者。内镜下胃空肠吻合因其微创优势,为研究热点。本课题采用经胃内镜下两步法胃空肠旁路技术,建立胃空肠吻合。目的：评价两步吻合技术(胃粘膜层-空肠浆肌层吻合继以胃粘膜层-空肠粘膜层吻合)实现经胃内镜下胃空肠吻合的可行性。研究场所：动物实验中心实验设计：(1)离体实验；(2)活体实验(非存活实验→存活实验) 研究对象：新鲜带空肠猪胃；雌性家猪(重15-20kg)(非存活组6只,存活组3只) 方法：双孔道胃镜下,钩刀划开胃壁,建—约2cm线形造口。尼龙圈联合异物钳法抓取空肠对系膜侧,并将其经胃造口提至胃内进行吻合：异物钳穿过尼龙圈环内提起空肠使其进入尼龙圈环,收紧尼龙圈,结扎环内空肠组织形成假息肉样外观。释放尼龙圈,预先绑于尼龙圈环的丝线即与胃镜分离,换以丝线提拉肠管。胃空肠吻合分两步进行：(1)胃粘膜层-空肠浆肌层吻合：钛夹将尼龙套扎圈分别夹于胃造口旁粘膜面、空肠浆膜面,收紧套扎圈,完成1对胃粘膜层-空肠浆肌层吻合。重复上述步骤,环周完成4-5对胃粘膜层-空肠浆肌层吻合。(2)胃粘膜层-空肠粘膜层吻合：钩刀划开空肠壁/高频电圈套器通电切除尼龙圈结扎形成的假息肉组织,钛夹将外翻空肠粘膜与胃粘膜直接钳夹连接,完成1对胃粘膜层-空肠粘膜层吻合。相邻钛夹间距5mm,环周完成8-10对胃粘膜层-空肠粘膜层吻合。记录操作时间、手术成败分析。存活组术后观察1周,记录吻合口漏发生情况与尸解结果。观察指标：技术可行性与并发症情况。结果：总术时约1.5-2小时,吻合时间约60-90分钟。成功吻合6例(3例非存活组,3例存活组)。非存活组中,2例因胃网膜动脉损伤继发出血,1例因肠管滑脱中止。存活组中,1例术后4天证实吻合口漏。实验缺陷：小样本短时间动物实验。结论：经胃内镜下两步法胃空肠吻合技术可行,效果肯定。
[Abstract]:Background: gastrojejunal bypass surgery is used in patients with malignant obstruction of gastric output tract, pancreaticoduodenal exclusion and volume reduction. Endoscopic gastrojejunostomy is a hot topic because of its minimally invasive advantage. Two-step gastrojejunal bypass technique was used to establish gastrojejunostomy. Objective: to evaluate the feasibility of two-step anastomosis (gastric mucosal layer jejunoplasmic layer anastomosis followed by gastric mucosal layer jejunal layer anastomosis). Study place: experimental design of animal experimental center: (1) in vitro experiment; (2) in vivo experiment (in vivo experiment); in fresh jejunal pig stomach; in female domestic pig (heavy 15-20kg) (6 in nonsurvival group). Survival group (3 rats): under double-channel gastroscopy, the hook knife was used to open the gastric wall and build-about 2cm line orifice. The nylon ring combined with foreign body forceps was used to capture the mesenteric side of the jejunum, and the jejunum was removed to the stomach for anastomosis through the stomstomy of the stomach: the foreign body forceps lifted the jejunum through the nylon ring to make it enter the nylon ring and tighten the nylon ring. The jejunum in ligation ring forms pseudopolypoid appearance. Release the nylon loop, the silk thread preattached to the ring is separated from the gastroscope and replaced with a silk thread to pull the intestine. Gastrojejunostomy was performed in two steps: (1) gastric mucosal layer anastomosis with jejunal muscular layer anastomosis: titanium clip and nylon ligation loop were respectively clamped on the mucosa side of gastric orifice and jejunum serosa surface, the ligation circle was tightened, and 1 pair of gastric mucosal lamina jejunum muscular layer anastomosis was completed. Repeat the above steps and complete 4-5 pairs of anastomosis of gastric mucosal layer and jejunum muscle layer around the ring. (2) gastric mucosal lamina jejunal mucosal anastomosis: the hook knife cuts open the wall of the jejunum / high frequency electric trap enelectrically excises the pseudopolypus tissue from the ligation of the nylon ring. Titanium clip connected the valgus jejunum mucosa with gastric mucosal clamp directly to complete 1 pair of gastric mucosal layer-jejunal mucosal layer anastomosis. The interval between the adjacent titanium clips was 5 mm, and the anastomosis of gastric mucosal layer to jejunal mucosal layer was completed in the circumference of 8-10 pairs. Record operation time, operation success and failure analysis. In the survival group, the anastomotic leakage and autopsy results were recorded 1 week after operation. Outcome measures: technical feasibility and complications. Results: the total operative time was 1. 5-2 hours and the anastomosis time was 60-90 minutes. Successful anastomosis was performed in 6 cases (3 cases in non-survival group and 3 cases in survival group). In the nonsurvival group, 2 cases suffered secondary hemorrhage due to gastric omentum artery injury, and 1 case was suspended because of intestinal slippage. In the survival group, anastomotic leakage was confirmed in 1 case 4 days after operation. Experiment defect: small sample short time animal experiment. Conclusion: two-step gastrojejunostomy is feasible and effective.
【学位授予单位】：武汉大学
【学位级别】：博士
【学位授予年份】：2011
【分类号】：R-332

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