目的探讨完全腹腔镜下肠肠吻合技术在消化道畸形治疗中运用的可行性及安全性。方法回顾性分析2015年1月至2015年12月完全腹腔镜下肠切除肠吻合治疗8例消化道畸形患儿的临床资料。其中，男6例，女2例；年龄1岁10个月～12岁8个月，平均5....目的探讨完全腹腔镜下肠肠吻合技术在消化道畸形治疗中运用的可行性及安全性。方法回顾性分析2015年1月至2015年12月完全腹腔镜下肠切除肠吻合治疗8例消化道畸形患儿的临床资料。其中，男6例，女2例；年龄1岁10个月～12岁8个月，平均5.4岁。患儿取仰卧位，气管插管。脐轮右上、左下分别置入3.5、5.0 mm Trocar。腹腔镜监视下，经病变于腹壁体表投影水平与左/右腹直肌外侧缘交界处置入5 mm Trocar。脐轮左上Trocar置入3 mm目镜，另2个5 mm Trocar置入操作器械。探查肠管，找到病变位置后，超声刀切除病变两端肠管，经腹壁进针（4-0带针丝线），浆肌层缝合两断端肠壁后牵引。5-0可吸收线连续全层缝合肠腔后壁（超过系膜侧肠壁），前壁连续浆肌层单层缝合。结果本组8例均顺利完成完全腹腔镜下肠切除肠吻合。手术时间1.5～2.5 h，平均1.9 h。术中均未出血，术后6～12 h下床活动，疼痛均可耐受。术后未见切口感染、吻合口漏及粘连性肠梗阻发生。病理检查报告肠重复畸形5例，梅克尔憩室3例。结论完全腹腔镜下肠肠吻合技术对于部分消化道畸形患儿是安全、有效的技术，但在病例选择上要严格把握指征。展开更多
Background The biofragmentable anastomosis ring （BAR） is a simple alternative device to create intestinal anastomosis. Our study was designed to evaluate the clinical value of BAR in intestinal anastomosis. Methods ...Background The biofragmentable anastomosis ring （BAR） is a simple alternative device to create intestinal anastomosis. Our study was designed to evaluate the clinical value of BAR in intestinal anastomosis. Methods A total of 167 patients performed intestinal anastomosis from January 2002 to February 2006 were randomized to BAR group （n=82） and manual suture group （n=-85） as control. They were equally allocated to the two groups regarding sex, age, site of anastomosis, emergent or elective surgery and contaminant diseases. The results of postoperative complications and recovery were recorded in each group. Results Eighty-seven intraperitoneal BAR anastomoses were completed in 82 patients. Two and one postoperative deaths were recorded in BAR and suture group, respectively, no deaths were directly related to anastomotic technique. In suture group, anastomotic leakage and early bleeding both occurred in two patients respectively, no anastomotic bleeding occurred in BAR group, one patient in BAR group developed enterocutaneous fistulae. Perioperative bleeding, operation time and length of hospitalization were similar in two groups （P 〉0.05）. Time for return of bowel function was significantly shortened in BAR group than that in suture group （P 〈0.05）. Conclusion The BAR appears to be a standard, easy, safe and effective alternative either in elective or emergent intraperitoneal intestinal anastomotic surgery.展开更多
Background A new procedure of colonic anastomosis with a degradable stent has already been proven to be simple, feasible, and safe in our porcine model. In this study, we evaluated its impact on the colonic physiologi...Background A new procedure of colonic anastomosis with a degradable stent has already been proven to be simple, feasible, and safe in our porcine model. In this study, we evaluated its impact on the colonic physiologic functions. Methods A total of 20 pigs were assigned randomly to either a stent anastomosis group （SA, n=10） or a conventional anastomosis group （CA, n=10）. Colonic anastomosis with a degradable stent was performed in the SA group, and conventional hand-sewn anastomosis was performed in the CA group. Body weight, fecal weight, total colonic transit time, immunohistochemistry staining of interstitial cells of Cajal （ICC）, plasma diamine oxidases （DAO） levels, and Western blotting analysis of occludin were evaluated before and after anastomosis. Results No obvious diarrhea or constipation was observed in all pigs. No significant difference in body weight between the groups was detected at any time. Yet, the fecal weight was less in the CA group compared with the SA group on postoperative day （POD） 7. No observable colonic paralysis or retention occurred. For total colonic transit time, there was no significant difference between the two groups at any time or among different time points in the same group. The integrated optical density of ICC showed no significant difference on either POD 14 or 30. The plasma DAO levels were remarkably elevated after surgery, and began to decrease since POD 3. However, there was no significant difference between both two groups in plasma DAO levels at any time either. For both groups, the expression of occludin was not significantly different from their pre-surgery level on either POD 14 or 30. Conclusions According to these results, this procedure with a degradable stent was supposed to be the same as the conventional hand-sewn procedure in their impact on the colonic physiologic functions.展开更多
目的在射频能量的作用下,通过新型压力可控电极对猪小肠(回肠部分)进行焊接,验证能量组织焊接技术对于肠道结构重建的可行性和安全性。方法将新鲜猪小肠按"黏膜-浆膜"嵌套在负电极上,通过施压圆锥体对正电极施加不同的压合压...目的在射频能量的作用下,通过新型压力可控电极对猪小肠(回肠部分)进行焊接,验证能量组织焊接技术对于肠道结构重建的可行性和安全性。方法将新鲜猪小肠按"黏膜-浆膜"嵌套在负电极上,通过施压圆锥体对正电极施加不同的压合压强(497、796、995、1194、1492 k Pa),在射频能量作用下完成肠道组织的焊接,通过撕脱力和爆破压测试研究焊接吻合口的生物力学特性,并对组织热扩散和微观组织结构进行检查。结果在能量输出功率160 W,压合压强995 k Pa,焊接时间为13 s时,肠道吻合口呈现最优的生物力学特性,其撕脱力和爆破压分别达到(8.73±1.11)N和(8.29±0.41)k Pa,且组织微观结构较完整,并能观察到少量游离胶原蛋白。结论射频能量组织焊接技术具有良好的应用前景,能够实现肠道组织快速、稳定的连接,对缩短手术时间、简化操作流程并提高手术质量,具有重要意义。展开更多
文摘目的探讨完全腹腔镜下肠肠吻合技术在消化道畸形治疗中运用的可行性及安全性。方法回顾性分析2015年1月至2015年12月完全腹腔镜下肠切除肠吻合治疗8例消化道畸形患儿的临床资料。其中，男6例，女2例；年龄1岁10个月～12岁8个月，平均5.4岁。患儿取仰卧位，气管插管。脐轮右上、左下分别置入3.5、5.0 mm Trocar。腹腔镜监视下，经病变于腹壁体表投影水平与左/右腹直肌外侧缘交界处置入5 mm Trocar。脐轮左上Trocar置入3 mm目镜，另2个5 mm Trocar置入操作器械。探查肠管，找到病变位置后，超声刀切除病变两端肠管，经腹壁进针（4-0带针丝线），浆肌层缝合两断端肠壁后牵引。5-0可吸收线连续全层缝合肠腔后壁（超过系膜侧肠壁），前壁连续浆肌层单层缝合。结果本组8例均顺利完成完全腹腔镜下肠切除肠吻合。手术时间1.5～2.5 h，平均1.9 h。术中均未出血，术后6～12 h下床活动，疼痛均可耐受。术后未见切口感染、吻合口漏及粘连性肠梗阻发生。病理检查报告肠重复畸形5例，梅克尔憩室3例。结论完全腹腔镜下肠肠吻合技术对于部分消化道畸形患儿是安全、有效的技术，但在病例选择上要严格把握指征。
文摘Background The biofragmentable anastomosis ring （BAR） is a simple alternative device to create intestinal anastomosis. Our study was designed to evaluate the clinical value of BAR in intestinal anastomosis. Methods A total of 167 patients performed intestinal anastomosis from January 2002 to February 2006 were randomized to BAR group （n=82） and manual suture group （n=-85） as control. They were equally allocated to the two groups regarding sex, age, site of anastomosis, emergent or elective surgery and contaminant diseases. The results of postoperative complications and recovery were recorded in each group. Results Eighty-seven intraperitoneal BAR anastomoses were completed in 82 patients. Two and one postoperative deaths were recorded in BAR and suture group, respectively, no deaths were directly related to anastomotic technique. In suture group, anastomotic leakage and early bleeding both occurred in two patients respectively, no anastomotic bleeding occurred in BAR group, one patient in BAR group developed enterocutaneous fistulae. Perioperative bleeding, operation time and length of hospitalization were similar in two groups （P 〉0.05）. Time for return of bowel function was significantly shortened in BAR group than that in suture group （P 〈0.05）. Conclusion The BAR appears to be a standard, easy, safe and effective alternative either in elective or emergent intraperitoneal intestinal anastomotic surgery.
基金This research was supported by Key Projects of Science Technology of the Department of Zhejiang Province （No. 2012C13020-2）, International Program of China （No. 2012DFA30410）, and Zhejiang Provincial Natural Science Foundation of China （No. LY13H180001）.
文摘Background A new procedure of colonic anastomosis with a degradable stent has already been proven to be simple, feasible, and safe in our porcine model. In this study, we evaluated its impact on the colonic physiologic functions. Methods A total of 20 pigs were assigned randomly to either a stent anastomosis group （SA, n=10） or a conventional anastomosis group （CA, n=10）. Colonic anastomosis with a degradable stent was performed in the SA group, and conventional hand-sewn anastomosis was performed in the CA group. Body weight, fecal weight, total colonic transit time, immunohistochemistry staining of interstitial cells of Cajal （ICC）, plasma diamine oxidases （DAO） levels, and Western blotting analysis of occludin were evaluated before and after anastomosis. Results No obvious diarrhea or constipation was observed in all pigs. No significant difference in body weight between the groups was detected at any time. Yet, the fecal weight was less in the CA group compared with the SA group on postoperative day （POD） 7. No observable colonic paralysis or retention occurred. For total colonic transit time, there was no significant difference between the two groups at any time or among different time points in the same group. The integrated optical density of ICC showed no significant difference on either POD 14 or 30. The plasma DAO levels were remarkably elevated after surgery, and began to decrease since POD 3. However, there was no significant difference between both two groups in plasma DAO levels at any time either. For both groups, the expression of occludin was not significantly different from their pre-surgery level on either POD 14 or 30. Conclusions According to these results, this procedure with a degradable stent was supposed to be the same as the conventional hand-sewn procedure in their impact on the colonic physiologic functions.
文摘目的在射频能量的作用下,通过新型压力可控电极对猪小肠(回肠部分)进行焊接,验证能量组织焊接技术对于肠道结构重建的可行性和安全性。方法将新鲜猪小肠按"黏膜-浆膜"嵌套在负电极上,通过施压圆锥体对正电极施加不同的压合压强(497、796、995、1194、1492 k Pa),在射频能量作用下完成肠道组织的焊接,通过撕脱力和爆破压测试研究焊接吻合口的生物力学特性,并对组织热扩散和微观组织结构进行检查。结果在能量输出功率160 W,压合压强995 k Pa,焊接时间为13 s时,肠道吻合口呈现最优的生物力学特性,其撕脱力和爆破压分别达到(8.73±1.11)N和(8.29±0.41)k Pa,且组织微观结构较完整,并能观察到少量游离胶原蛋白。结论射频能量组织焊接技术具有良好的应用前景,能够实现肠道组织快速、稳定的连接,对缩短手术时间、简化操作流程并提高手术质量,具有重要意义。
