【摘要】：背景：胃空腸旁路手術用于胃輸出道惡性梗阻、胰十二指腸曠置及減容手術患者。內鏡下胃空腸吻合因其微創(chuàng)優(yōu)勢,為研究熱點。本課題采用經(jīng)胃內鏡下兩步法胃空腸旁路技術,建立胃空腸吻合。 目的：評價兩步吻合技術(胃粘膜層-空腸漿肌層吻合繼以胃粘膜層-空腸粘膜層吻合)實現(xiàn)經(jīng)胃內鏡下胃空腸吻合的可行性。 研究場所：動物實驗中心 實驗設計：(1)離體實驗；(2)活體實驗(非存活實驗→存活實驗) 研究對象：新鮮帶空腸豬胃；雌性家豬(重15-20kg)(非存活組6只,存活組3只) 方法：雙孔道胃鏡下,鉤刀劃開胃壁,建—約2cm線形造口。尼龍圈聯(lián)合異物鉗法抓取空腸對系膜側,并將其經(jīng)胃造口提至胃內進行吻合：異物鉗穿過尼龍圈環(huán)內提起空腸使其進入尼龍圈環(huán),收緊尼龍圈,結扎環(huán)內空腸組織形成假息肉樣外觀。釋放尼龍圈,預先綁于尼龍圈環(huán)的絲線即與胃鏡分離,換以絲線提拉腸管。胃空腸吻合分兩步進行：(1)胃粘膜層-空腸漿肌層吻合：鈦夾將尼龍?zhí)自Ψ謩e夾于胃造口旁粘膜面、空腸漿膜面,收緊套扎圈,完成1對胃粘膜層-空腸漿肌層吻合。重復上述步驟,環(huán)周完成4-5對胃粘膜層-空腸漿肌層吻合。(2)胃粘膜層-空腸粘膜層吻合：鉤刀劃開空腸壁/高頻電圈套器通電切除尼龍圈結扎形成的假息肉組織,鈦夾將外翻空腸粘膜與胃粘膜直接鉗夾連接,完成1對胃粘膜層-空腸粘膜層吻合。相鄰鈦夾間距5mm,環(huán)周完成8-10對胃粘膜層-空腸粘膜層吻合。記錄操作時間、手術成敗分析。存活組術后觀察1周,記錄吻合口漏發(fā)生情況與尸解結果。 觀察指標：技術可行性與并發(fā)癥情況。 結果：總術時約1.5-2小時,吻合時間約60-90分鐘。成功吻合6例(3例非存活組,3例存活組)。非存活組中,2例因胃網(wǎng)膜動脈損傷繼發(fā)出血,1例因腸管滑脫中止。存活組中,1例術后4天證實吻合口漏。 實驗缺陷：小樣本短時間動物實驗。 結論：經(jīng)胃內鏡下兩步法胃空腸吻合技術可行,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.
【學位授予單位】：武漢大學
【學位級別】：博士
【學位授予年份】：2011
【分類號】：R-332

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