猪内镜逆行胰管造影的实验研究

Experimental Study of Porcine Model for Endoscopic Retrograde Pancreatography

背景:内镜逆行胰管造影(ERP)是胰腺疾病的重要诊治手段之一,该技术需经验丰富的内镜医师操作,初学者操作会有一定风险。直接以患者为对象培训该技术有很大的局限性,因此寻找合适的动物模型成为内镜医师关注的问题。目的:对家猪行ERP,探讨其作为ERP操作培训动物模型的可行性和应用价值。方法:6只健康家猪术前肌内注射氯胺酮20mg镇静,动物安静后予腹腔注射3%戊巴比妥钠(30mg/kg)麻醉。麻醉稳定后行ERP操作和胰管支架植入。术中全程监测心率和呼吸。结果:4只家猪ERP操作获成功,2只找到胰管开口但操作失败。猪胆管与胰管不汇合,各自开口于十二指肠壁。造影显示胰管左右支汇合成主胰管,开口于十二指肠壁。ERP术后1d,部分动物血白细胞计数和淀粉酶水平显著升高,7d后基本恢复至正常水平。结论:对猪行ERP是可行的,且可采用较简单的麻醉方式。以猪为动物模型行ERP操作,可作为初学者培训的方法之一,也可用于相关医学研究。

Background： Endoscopic retrograde pancreatography （ERP） is an important procedure for evaluation and treatment of pancreatic diseases. The procedure should be performed by the experienced endoscopists, or it is risky if performed by a novice. There is limitation for training endoscopists by means of practising the ERP procedure on humans. Therefore, to find a suitable model for ERP is of importance for endoscopists. Aims： To appraise the feasibility and value of using pigs as a model for practising ERP by a novice. Methods： Six healthy pigs were used in this experimental study. After sedation with 20 mg ketamine I.M, 3% pentobarbital （30 mg/kg） was injected I.P. When the pig was under stable anesthesia, ERP was performed and a stent was inserted into the pancreatic duct. The whole procedure was carried out under electrocardiogram and respiratory monitoring. Results： ERP procedure was successfully performed in 4 pigs and failed in 2, although the opening of pancreatic duct was seen. Porcine bile duct and pancreatic duct had their own opening at the duodenum. Pancreatography demonstrated that the left and right branches of pancreatic duct merged into the main pancreatic duct with opening on the wall of duodenum. Blood leukocyte count and serum amylase level increased significantly on the first day after ERP in some pigs and returned to almost normal by the 7th day. Conclusions- Using pig as a model for ERP is feasible. A much simpler anesthetic modality for ERP in pigs has been developed. Porcine model for ERP can be used by novice to improve their technique and also can be used in related medical research studies.