腹腔镜下应用可降解可示踪支架行小肠吻合的研究

Experimental study of laparoscopic intestine anastomosis with a biodegradable and traceable stent

目的:通过动物实验来验证腹腔镜下应用可降解、可示踪支架进行小肠吻合的安全性、可行性。方法:纳入实验的32头实验猪(购自上海甲干生物科技有限公司)等额随机分配为两组:腹腔镜下小肠手工吻合对照组(C组)16头;腹腔镜下小肠支架吻合实验组(E组)16头。按分组进行小肠吻合手术,记录肠管吻合手术时间,术后14 d测量外周血检测白细胞计数和白蛋白水平,吻合口爆破压,吻合口组织羟脯氨酸含量和吻合口病理学情况。计量资料行单样本K-S正态分布检验,属正态分布的组间比较采用Student’s t检验。 结果:肠管吻合手术时间实验组为(10.14±1.64) min,对照组为(26.22±3.61) min,实验组手术时间短于对照组,组间差异有统计学意义( t=15.680, P<0.01)。术后14 d,血白细胞计数实验组为(15.09±1.06)个/μl,对照组为(15.14±1.06)个/μl;血白蛋白水平实验组为(35.09±0.95) g/L,对照组为(35.25±0.14) g/L;吻合口组织羟脯氨酸含量实验组为(3.58±0.23) mg/g,对照组为(3.55±0.20) mg/g;吻合口爆破压实验组为(324.90±32.92) mmHg(1 mmHg=0.133 kPa),对照组为(271.50±17.55) mmHg。血白细胞计数、血白蛋白水平、吻合口组织羟脯氨酸含量两组间差异无统计学意义( t=0.140、0.450、0.330, P>0.05),吻合口爆破压实验组显著高于对照组,差异有统计学意义( t=4.400, P<0.01)。术后14 d实验组腹部CT显示支架在位,可见支架出现虫蚀和破损样改变。吻合口病理检查两组均处于组织恢复期可见弱胶原沉积。 结论:腹腔镜下小肠支架吻合实验组手术时间短,术后14 d吻合口愈合情况等同于对照组,吻合口爆破压高于对照组,并能实现支架影像学示踪的功效。

Objective To develop a new method of laparoscopic intestine anastomosis with a biodegredable and traceable stent,evaluate the feasibility and outcome of this method in a porcine model.Methods Thirty two healthy Bama mini-pigs were included in this study and randomly divided in two groups of sixteen:laparoscopic handsewn anastomoses control group(C)and laparoscopic stent anastomoses experimental group(E).The pigs were sacrificed on postoperative days(PODs)14.The surgical time of intestine anastomosis,anastomotic bursting pressure,hydroxyproline content,peripheral white blood cell counts,peripheral albumin and pathology evidence of anastomosis were evaluated.Results The surgical time of intestine anastomosis of E group was(10.14±1.64)min and C group was(26.22±3.61)min.The surgical time of intestine anastomosis of E group was shorterer than C group(t=15.680,P<0.01).POD14,peripheral white blood cell counts of E group was(15.09±1.06)cells/μl and C group was(15.14±1.06)cells/μl.Albumin of E group was(35.09±0.95)g/L and C group was(35.25±0.14)g/L.Hydroxyproline content of E group was(3.58±0.23)mg/g and C group was(3.55±0.20)mg/g.Bursting pressure of E group was(324.90±32.92)mmHg(1 mmHg=0.133 kPa)and C group was(271.50±17.55)mmHg.There were no significant difference in peripheral white blood cell counts,albumin,hydroxyproline content between these two groups(t=0.140,0.450,0.330,P>0.05).Bursting pressure of E group was significantly higher than C group(t=4.400,P<0.01).Stents in E group were traced by CT scan and the stent began to biodegrade.Pathology evidence indicated that anastomotic stomas of the two groups were both in the recovering stage.Conclusion Laparoscopic intestine anastomosis with a biodegredable and traceable stent is a feasible and safe method in this porcine model.The cases of E group had shorter surgery time,and appears to be a trend that laparoscopic management with a stent offers a better short-term outcomes.