防返流吻合口支架治疗食管术后狭窄

目的：对传统的食管吻合口支架进行改进。方法：根据食管胃吻合口区的特殊解剖结构和吻合口狭窄的病变特点,对传统吻合口支架进行了一系列改进。透视下对42例食管癌、胃癌手术后吻合口狭窄的患者置放42枚防返流吻合口支架。结果：防返流吻合口支架可显著减轻病人置入支架后的疼痛、呕吐及胃液返流等症状,也可减少／减轻其食管再狭窄和支架移位等并发症,同时不影响对病人吞咽困难的改善。结论：防返流吻合口支架特点明显,对治愈食管癌、胃癌术后吻合口狭窄是一种比较理想的支架。     

覆膜食管支架治疗食管胃吻合口瘘12例

自 1999年开始 ,我们对收治的 12例食管癌术后胸内吻合口瘘的病人置入覆膜食管支架 ,取得满意效果 ,现报告如下。1　资料与方法1 1　一般资料 :12例病人中男 8例 ,女 4例 ;年龄 45～ 6 2岁 ,平均年龄 5 2 8岁。均为食管癌术后胸内吻合口瘘病人 ,其中弓上吻合 9例弓下吻合 3例 ,机械吻合 10例手工吻合 2例。经泛影葡胺造影证实为吻合口瘘 ,瘘口最大 2ｃｍ× 1ｃｍ ,最小0 2ｃｍ× 0 3ｃｍ ,吻合口瘘出现的时间为术后 3～ 9ｄ。临床发现吻合口瘘后立即禁食给予胸腔引流 ,抗感染、止酸治疗 ,同时行肠外营养改善营养状况 ,一周后置入食管支架…     

胃粘膜成形食管胃吻合实验研究

目的 :探讨食管胃吻合抗反流术式。方法 :以犬为实验对象。在胃底前壁剥除约 8× 4cm浆肌层成形为粘膜管 ,食管粘膜延长 1 5cm与胃部成形粘膜管分层吻合。分别于手术后 7～ 180天处死检测 ,同“深套叠”术式对比分析。结果 :残留粘膜血供良好。肌层吻合口直径及突入胃腔内结构长度两组无差别 (P >0 .0 5 ) ,粘膜吻合口直径差异显著 (P <0 .0 1)。实验组能耐受较高胃内压 ,胃与食管压力差两组比较有显著性差异 (P <0 .0 1)。突向胃腔内结构厚度两组比较相差 1倍以上。结论 :①适当剥除肌层不引起粘膜缺血坏死。②成形粘膜瓣较薄 ,在食管与胃压力差作用下关闭性强 ,具有良好抗反流效果。③不同平面分层吻合具有一定预防吻合口瘘及狭窄作用     

经腹入路近端胃切除胃食管及空肠侧侧吻合的抗返流应用研究

目的:探讨经腹入路近端胃切除术后胃食管吻合的抗返流效果。方法:采用近端胃食管吻合+幽门成形(Heinecke氏法)+距屈氏韧带约20～25cm近端空肠与输出袢远端空肠行侧侧(Braun’s)全层间断缝合吻合。结果:对37例实验组患者实行该术式操作,均获得满意恢复,抗返流效果明显优于传统术式,有效减少术后返流性食管炎及吻合口瘘等并发症,提高了患者术后生活质量,效果满意。结论:近端胃切除术后,行近端胃食管吻合+幽门成形+距屈氏韧带约20～25cm近端空肠与输出袢远端空肠行侧侧(Braun’s)全层间断缝合吻合抗返流方法安全可行。     

吻合器行食管胃前壁吻合近端胃切除中抗返流的作用分析

目的：对吻合器行食管胃前壁吻合近端胃切除中抗返流的手术操作技术进行分析与评价。方法选取胃切除的患者56例,将其按随机分组原理均分为观察组和对照组（n=28）,对照组应用吻合器行食管胃后壁端侧吻合的手术方法进行治疗,观察组采用吻合器行食管胃前壁吻合进行治疗。进行为期1年的随访,在随访期间详细记录2组患者的返流性食管炎发生情况及并发症的发生概率,并进行对比分析。结果观察组返流性食管炎的总发生率为25.0%,对照组返流性食管炎的总发生率为53.6%,2组差异具有统计学意义（P<0.05）。且观察组的并发症发生率显著小于对照组并发症的发生率（P<0.05）。结论吻合器行食管胃前壁吻合术具有良好的临床效果,值得推广。     

隧道式胃食管吻合体会

1 一般资料我院自1986年1月—1993年12月,先后为13例贲门癌病人做了上半胃切除,隧道式胃食管吻合术.其中男11例,女2例.年龄47岁—62岁.13例病人手术后经过顺利.其中有11例术后4—8个月做了随访,11例病人都能进普通饮食,吞咽时无任何不适感觉.2 手术方法(1)经胸切除上半胃,下半胃残端     

食管,胃吻合口瘘的非手术治疗：附6例报告

食管、胃吻合口瘘是食管切除、食管重建术后较严重的并发症,发生率为2.6～6.4％。一旦发生死亡率高达50以上。二次手术治疗只适用于一般情况较好,吻合口瘘发生时间短,感染轻的患者,仅占吻合口瘘病人一小部分,因而非手术的综合性治疗成为吻合口瘘治疗的一种主要手段。本文对我院6例吻合口瘘非手术治疗进行总结和讨论。     

可降解内支架法结肠吻合技术对结肠生理功能影响的动物实验研究

背景 我们发展了一种应用可降解支架行结肠吻合的新技术,在以往的在巴马小型猪动物实验上已经证实了这种支架和技术是简单、可行并且安全的。本研究将评估这种支架和技术对肠道生理功能的影响。 方法 将20只猪随机分配至支架吻合组（SA, n=10）和常规吻合组（CA, n=10）。SA组行可降解内支架法结肠吻合。CA组行常规的手工吻合。手术前后分别测量或分析体重、粪便重量、全结肠传输时间、Cajal间质细胞免疫组化、血二胺氧化酶水平以及occludin蛋白免疫印迹。 结果 所有实验动物未出现明显的腹泻或便秘。在各个时间点上,两组实验动物的体重无明显差异,CA组在术后第七天的粪便重量较SA组显著减少。所有实验动物均未出现肠麻痹或肠梗阻。全结肠传输时间在各个时间点上无组间差异,且在组内各个时间点上也无显著差异。在各个时间点上,两组实验动物肠道切片的Cajal间质细胞积分光密度值无显著差异。术后两组实验动物的血二胺氧化酶值都显著上升,在术后3-7天内的某一时间开始下降,两组间无显著差异。两组实验动物术后14天与30天肠标本的occludin蛋白免疫印迹结果均与它们的术前水平无显著差异。 结论 在评价对肠道生理功能的影响方面,可降解内支架法结肠吻合法与常规手工吻合方法相比无显著差异。     

胃底壁圆形切除、食管胃单层吻合预防颈部吻合口狭窄

目的 通过改变吻合方法，降低食管中上段癌食管胃吻合口狭窄的发生率。方法 采用胃底壁圆形切除、颈部食管胃单层吻合法治疗512例食管中上段癌患者，分析减少吻合口狭窄的机制。结果 全组发生颈部吻合口狭窄8例（1．56％），吻合口瘘6例（1．02％）。结论 此方法可显著降低吻合口狭窄的发生率，提高患者的生存质量。     

防反流食管支架治疗食管癌术后吻合口狭窄

目的 应用防反流食管支架治疗食管癌术后吻合口狭窄及预防反流性食管炎。方法 对26例食管癌术后吻合口狭窄患者，于透视下先时狭窄段扩张。再用食管支架输送器推送、释放下口装置有防反流瓣膜的带膜食管支架。结果 26例支架均一次性放置成功，术后所有患者吞咽困难症状显著改善；随访6-9个月，支架保持开放，食管保持通畅，21例未出现胃食管反流现象；5例有轻微胃食管反流现象。结论 防反流食管支架能够有效治疗食管癌术后吻合口狭窄及预防反流性食管炎。     

可生物降解肠吻合支架的动物实验研究

目的利用一种拥有自主研发的可降解肠吻合支架进行犬肠吻合术,观察该吻合支架的可操作性及对吻合口并发症预防的作用。方法实验犬分实验组和对照组,麻醉后分别进行手工缝合及利用该吻合器进行拟定肠段的全层吻合,术后第7、14天时分批处死实验犬,对吻合口爆破压、吻合口周径、肠管周径、吻合口部位羟脯氨酸含量等项目进行观测。结果利用吻合支架进行的肠吻合,其吻合口爆破压、羟脯氨酸含量等观测数据均优于对照组,吻合口周径、肠管周径两组无差异。结论该吻合器操作简单、快速、安全,可有效预防及降低术后吻合口并发症,值得继续深入研究。     

机械吻合和手工吻合两种食管癌切除术的比较

目的探讨食管癌切除食管胃颈部机械吻合及手工吻合两种手术方式的并发症及防治。方法 2004年9月~2008年6月,将颈段及胸中、上段食管癌并具有手术适应症的患者随机分为两组即手工吻合组(手工组)和圆形吻合器机械吻合组(机械组),比较两组吻合口瘘、狭窄等的并发症。结果手工组125例,机械组102例,吻合瘘发生率分别为14.4%(18/125)、2.9%(3/102),狭窄需扩张分别为8.8.%(11/125),3.9%(4/102)。颈部吻合时间分别为(52±12)min和(25±5)min,差别显著(P<0.01)。结论食管癌切除食管胃颈部采用圆形吻合器端侧吻合吻合口瘘发生率低,手术时间缩短,操作简便,易于掌握及标准化,有利于降低吻合口的并发症。     

食管癌切除胃食管颈部吻合的改进与并发症防治

目的探讨食管癌切除胃-食管颈部吻合的不同吻合方法的手术疗效。方法回顾性分析428例胃-食管颈部吻合的食管癌患者,比较吻合器吻合和不同手工吻合的术后与吻合技术相关的并发症的发生率。结果器械吻合组吻合手术时间较手工吻合组均显著缩短(P<0.01),术后颈部吻合口瘘、吻合口狭窄、死亡率,手工吻合组1分别为14.1%、25.4%、2.8%,手工吻合组2分别为:6.3%、13.8%、1.3%,器械吻合组分别为:0.0%、3.2%、0.8%。结论随着颈部手工吻合技术的不断改进,手术并发症明显降低。吻合器的应用又进一步完善了颈部吻合技术,值得推广应用。     

Short-term safety and efficacy of the biodegradable iron stent in mini-swine coronary arteries

Background Iron can potentially serve as the biomaterial for biodegradable stents. This study aimed to assess the short-term safety and efficacy of a biodegradable iron stent in mini-swine coronary arteries.

Methods Eight iron stents and eight cobalt chromium alloy (VISION) stents as control were randomly implanted into the LAD and RCA of 8 healthy mini-swine, respectively. Two stents of the same metal base were implanted into one animal. At 28 days the animals were sacrificed after coronary angiography, and histopathological examinations were performed.

Results Histomorphometric measurements showed that mean neointimal thickness ((0.46±0.17)mm vs. (0.45±0.18)mm, P＝0.878), neointimal area ((2.55±0.91)mm² vs. (3.04±1.15)mm², P＝0.360) and percentage of area stenosis ((44.50±11.40)% vs. (46.00±17.95)%, P=0.845) were not significantly different between the iron stent and VISION stent groups. There was no inflammation, thrombosis or necrosis in either group. The SEM intimal injury scores ((0.75±1.04) vs. (0.88±0.99), P＝0.809) and rate of proliferating cell nuclear antigen (PCNA) positive staining cells were not significantly different between the two groups. The percentage of neointimal coverage by SEM examination was numerically higher in iron stents than in VISION stents ((84.38±14.50)% vs. (65.00±22.04)%, P＝0.057), but there was no significant difference statistically between the two groups. At 28 days iron staining in the tissue surrounding iron stents was positive and the vascular wall adjacent to the iron stent had a brownish tinge, consistent with iron degradation. No abnormal histopathological changes were detected in coronary arteries and major organs.

Conclusions The biodegradable iron stent has good biocompatibility and short-term safety and efficacy in the mini-swine coronary artery. Corrosion of iron stent is observed at 4 weeks and no signs of organ toxicity related to iron degradation are noted.

     

Short-term safety and efficacy of the biodegradable iron stent in mini-swine coronary arteries

Background To overcome the drawbacks of permanent years. The bioabsorbable polymer vascular scaffold （BVS） stents, biodegradable stents have been studied in recent was the first bioabsorbable stent to undergo clinical trials, demonstrating safety and feasibility in the ABSORB studies. Iron can potentially serve as the biomatedal for biodegradable stents. This study aimed to assess the short4erm safety and efficacy of a biodegradable iron stent in mini-swine coronary arteries. Methods Eight iron stents and eight cobalt chromium alloy （VISION） control stents were randomly implanted into the LAD and RCA of eight healthy mini-swine, respectively. Two stents of the same metal base were implanted into one animal. At 28 days the animals were sacrificed after coronary angiography, and histopathological examinations were performed. Results Histomorphometric measurements showed that mean neointimal thickness （（0.46±0.17） mm vs. （0.45±0.18） mm, P=0.878）, neointimal area （（2.55±0.91） mm2 vs. （3.04±1.15） mm2, P=0.360） and percentage of area stenosis （（44.50±11.40）% vs. （46.00±17.95）%, P=0.845） were not significantly different between the iron stents and VISION stents. There was no inflammation, thrombosis or necrosis in either group. The scanning electron microscopy （SEM） intimal injury scores （0.75±1.04 vs. 0.88±0.99, P=0.809） and number of proliferating cell nuclear antigen （PCNA） positive staining cells were not significantly different between the two groups. The percentage of neointimal coverage by SEM examination was numerically higher in iron stents than in VISION stents （（84.38±14.50）% vs. （65.00±22.04）%, P=0.057）, but the difference was not statistically significant. Iron staining in the tissue surrounding the iron stents at 28 days was positive and the vascular wall adjacent to the iron stent had a brownish tinge, consistent with iron degradation. No abnormal histopathological changes were detected in coronary arteries or major organs. Conclusions The biodegradable iron stent has good biocompatibility and short-term safety and efficacy in the mini- swine coronary artery. Corrosion of iron stents is observed at four weeks and no signs of organ toxicity related to iron degradation were noted.     

Changes of the colonic physiologic functions after colonic anastomosis with a degradable stent in a porcine model

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.     

生物可降解吻合环、吻合器在右半结肠切除术中的应用比较

目的 比较右半结肠切除术中生物可降解吻合环(BAR)、吻合器两种方法的吻合效果.方法 回顾性分析我院87例右半结肠切除术,其中49例用吻合器吻合,38例用BAR吻合,比较二者术后吻合口瘘、吻合口狭窄、腹腔感染、术后肠梗阻、消化道出血、切口感染等的发生率及肠功能恢复时间、材料费用等.结果 两种方法均无吻合口瘘、吻合口狭窄、腹腔感染、术后肠梗阻等发生.吻合器法中1例出现下消化道出血、3例切口感染,BAR法中2例切口感染,差异均无统计学意义.吻合器法肠功能恢复时间平均为3.5d,BAR法肠功能恢复时间平均为3.1d,差异无统计学意义,但BAR法肠功能恢复时间明显早于吻合器法.吻合器法费用(管状吻合器加闭合器)平均约5 231元人民币,BAR约3 427元人民币.结论 生物可降解吻合环在右半结肠切除术中的应用与管状吻合器同样安全可靠;比吻合器更有利于患者肠功能的恢复、更经济实用.     

新型生物可降解雷帕霉素药物洗脱输尿管支架的构建及性能评估

目的：构建一种新型生物可降解雷帕霉素药物洗脱输尿管支架并评估其机械性能及药物释放特性。方法采用聚乳酸为原料,将其溶于氯仿后加入雷帕霉素粉末,通过溶液挥发法构建螺旋形生物可降解雷帕霉素药物洗脱输尿管支架。通过万能压力机检测新型生物可降解雷帕霉素输尿管支架力学性能,并分别在3周、6周、9周和12周时通过色谱分析仪评估其药物释放特性。结果成功构建的生物可降解雷帕霉素药物洗脱输尿管支架,长度为50 mm,内径为0.8 mm,外径1.4 mm,厚度为200μm,带宽为1 mm。支架不仅具有良好的力学性能,并可有效持续释放药物,支架平均雷帕霉素含量为2755μg,3周后支架平均含药量为2670μg,6周后支架平均含药量为2533μg,9周后支架平均含药量为1541μg,12周后支架平均含药量为744μg。结论构建的生物可降解雷帕霉素药物洗脱输尿管支架具有良好的机械性能,可有效释放药物,有望为输尿管损伤或狭窄的治疗提供一种新的简单有效的材料和方法。     

生物可降解与非可降解涂层支架临床应用的meta分析

目的对生物可降解聚合物涂层药物支架与非可降解药物洗脱支架应用于我国冠心病人群的安全有效性进行meta分析。方法通过计算机搜索国内外电子数据库,并结合文献追溯方式,收集已公开发表与生物可降解聚合物涂层药物支架（biodegradable polymer drug eluting stent,BPS）与永久聚合物涂层支架（permanent polymerdrug eluting stent,PPS）相关的临床对照研究资料,对随访末期主要不良心血管事件（major adverse cardiac events,MACE）、支架内血栓事件（stent thrombosis,ST）及支架内晚期管腔丢失（late lumen loss,LLL）情况进行meta分析,探讨BPS在我国冠心病人群中晚期应用的安全性及有效性。结果共纳入国内公开发表的研究共7篇文献,共有2 533名患者分别植入BPS及PPS。BPS与PPS两组之间,1年随访末期MACE发生差异无统计学意义（OR=0.94,95%CI：0.68～1.32,Z=0.34,P=0.74〉0.05）,1年支架内血栓事件发生差异无统计学意义（OR=1.73,95%CI：0.59～5.04,Z=1.00,P=0.32〉0.05）,随访末期血管造影支架内LLL发生无统计学差异（WMD=-0.02,95%CI：-0.24～0.19,Z=0.22,P=0.83〉0.05）。结论根据目前研究结果,BPS应用于中国人群其安全性并不劣于PPS,而以支架内LLL作为评价标准,BPS早期也并未表现出预期降低管腔丢失的优势。BPS的理论优越性尚需要随访时间更长、规模更大的临床研究来证实。