磁压榨吻合技术治疗结直肠吻合及重建中的应用分析

回顾磁压榨吻合技术(magnetic compression anastomosis, MCA)治疗不同原因、不同类型肠道狭窄/闭锁实现肠道再通的案例, 对MCA在结直肠吻合及重建中的临床应用进行分析探讨。4例患者2019年5月—2022年8月在西安交通大学第一附属医院及西北妇女儿童医院行结直肠MCA再通治疗。患者手术过程均顺利, 实现肠道吻合再通, 磁环排出时间为7～15 d, 术后复查肠镜或造影提示吻合口完好。MCA可用于治疗不同原因、不同类型的结直肠狭窄及闭锁, 也可用于辅助结直肠手术肠吻合。     

经内镜球囊扩张术治疗结直肠吻合口良性狭窄

目的 探讨经内镜球囊扩张术治疗结、直肠吻合良性狭窄的临床效果。方法 经肠镜球囊扩张治疗结直肠吻合口良性狭窄15例，其中乙状结肠切除患者1例，直肠前切除患14例；吻合器吻合13例，手缝2例；狭窄处直径0.2～0.7cm，狭窄长度0.5～2.0cm。结果 13例经1次扩张，2例经2次扩张，狭窄处均被扩至2～2.5cm，成功率100%，无一出现并发症。随访3～30个月，无狭窄复发 。结论 经内镜球囊扩张术是一种安全、简单、有效的方法，应成为治疗结直肠吻合口良性狭窄的首选方法。     

内镜辅助下磁压榨术治疗直肠癌术后吻合口闭锁初探

目的 评估内镜辅助下磁压榨术治疗直肠癌根治术后吻合口闭锁的可行性与安全性。方法 2019年5月,在西安交通大学第一附属医院就诊的直肠癌术后吻合口闭锁患者1例,使用小肠镜,经回肠末端造瘘口逆行末端回肠、结肠,将磁环送达直肠吻合口处,经肛门徒手置入另一半磁环,手指触摸及小肠镜下观察确认两片磁环隔吻合口吸引固定。对患者的治疗及随访情况进行总结和分析。结果 患者顺利完成内镜辅助下磁压榨术,手术用时1.5 h。治疗过程无并发症发生。术后约13 d磁环脱落,肠镜检查提示吻合口再通,再通处可见吻合钉残留,直径约0.6 cm。结论 内镜辅助下磁压榨术治疗直肠癌术后吻合口闭锁短期效果可靠,可实现吻合口再通,为消化道闭锁患者后期进行传     

内镜下环周切开术治疗难治性结直肠吻合口良性狭窄的临床疗效观察

[目的]评价内镜下环周切开术治疗结直肠吻合口良性顽固性狭窄的安全性和疗效。[方法]选取行内镜下环周切开术治疗因结直肠癌术后出现吻合口良性难治性狭窄患者35例,观察手术安全性及其临床疗效。[结果]35例均顺利行内镜下环周切开治疗,吻合口直径从2～6 mm扩张至13～18 mm(平均15 mm)。手术时间15～25 min。所有患者腹胀、排便困难症状均有明显改善,术后有效率为100%,较术前相比差异有统计学意义(P0.01)。术后第1、3、6个月随访观察患者无一例出现腹痛、便血、发热及肠穿孔等并发症。术后第6个月复查结肠镜,33例常规结肠镜可顺利通过,2例于术后第6个月复查提示再发狭窄,遂进行再次环周切开治疗。[结论]内镜下环周切开术对治疗难治性结直肠吻合口良性狭窄是一种安全有效的治疗方法。     

内镜下电切治疗难治性结直肠吻合口良性狭窄二例

2011年7月至2012年8月间,中南大学湘雅二医院消化内科应用末端绝缘手术刀（IT刀）电切治疗难治性结直肠吻合口良性狭窄2例,临床疗效满意,报道如下。     

内镜下球囊扩张术治疗结直肠吻合口良性狭窄的临床回顾性分析

目的评价内镜下球囊扩张术（EBD）治疗结直肠吻合口良性狭窄的安全性及疗效。方法2011年至2015年,复旦大学附属中山医院内镜中心行EBD治疗的36例结直肠吻合口良性狭窄病例纳入回顾性分析,统计扩张治疗次数、并发症发生情况、短期效果及长期狭窄复发情况。结果36例患者在外科手术后2～49个月（中位时间6个月）出现吻合口狭窄,吻合口距肛缘3～24 cm（中位距离6 cm）。10例(27.8%)为1级狭窄,15例(41.7%)为2级狭窄,11例(30.5%)为3级狭窄。36例共行80次EBD,平均每例2.22次,其中行1～2次25例（69.4%）、3次及以上11例（30.6%）。EBD操作过程中,14例次(17.5%)出现吻合口少量渗血,无术中及术后穿孔发生。术后所有患者梗阻症状得到解除,吻合口直径大于20 mm,EBD治疗取得成功。术后随访22～76个月（中位时间44个月）,其中4例(11.1%)在EBD治疗成功后再次出现吻合口良性狭窄,出现时间分别为末次扩张术后的7、11、18、63个月,均经再次EBD治疗后好转。结论EBD在治疗结直肠吻合口良性狭窄方面安全有效,能取得较为理想的短期和长期结局。     

黏膜切开联合蕈型覆膜金属支架及球囊扩张治疗重度结直肠吻合口良性狭窄一例

目前内镜下治疗已成为结直肠癌术后吻合口良性狭窄的首选,然而对于直肠下段重度吻合口狭窄而言,仍是临床治疗的难点。本文报道了1例直肠下段重度吻合口良性狭窄病例,通过黏膜切开联合蕈型覆膜金属支架及柱状球囊扩张治疗取得了良好效果。     

直肠癌微创手术后吻合口漏的微创再手术研究进展

近二十年来微创手术方式逐步成为治疗直肠癌的标准术式,但是与开腹手术方式相比,仍未能降低直肠癌术后发生吻合口漏的风险.吻合口漏仍是直肠癌术后主要的并发症之一,影响着患者的肿瘤学预后和生活质量,也是腹腔镜结直肠外科医师需要面临的挑战.对于需要手术干预的吻合口漏,选择传统的开腹再手术的处理方式,还是选择微创再手术的处理方式一...     

机械吻合器在食管癌切除术中预防吻合口狭窄的价值研究

目的探讨机械吻合器应用于食管癌切除术中预防吻合口狭窄的临床效果。方法将2007年以来接受食管癌切除术123例患者作为治疗组施行胃食管机械吻合,查找1990年之前的病历资料31例为对照组,采用传统的方法,胃食管单纯手工吻合法。结果治疗组患者术后随访3～24个月,通过食管吞钡摄片或胃镜检查,发现1例出现吻合口狭窄。对照组术后随访3～24个月,通过胃镜或食管吞钡摄片证实7例有不同程度的吻合口狭窄。结论胃食管机械吻合有降低食管癌切除术后吻合口狭窄发生率的优点,手术时间短,有效减轻患者术后的痛苦,提高生存质量,值得临床上推广应用。     

直肠癌术后吻合口良性狭窄80例诊治分析

目的探讨直肠癌根治术后出现良性吻合口狭窄的发生情况及治疗方法。 方法对福建医科大学附属漳州市医院80例直肠癌术后出现良性吻合口狭窄患者的临床资料进行回顾性分析,包括患者一般情况、术前和术中情况、术后并发症、吻合口狭窄情况、治疗经过及治疗结局。 结果80例吻合口良性狭窄患者中,低位狭窄56例（71.8%）、高位狭窄24例（18.2%）,其中预防性造口52例（65.0%）,术后吻合口漏38例（47.5%）,术前放化疗8例（10.0%）。借助指检扩肛方式治疗者40例（50.0%）,指检治愈率85%（34/40）;通过内镜球囊扩张32例（40.0%）,扩张次数的中位数为2次（1~4次）,内镜下治愈率50%（16/32）;留置肛管后解除狭窄4例（5.0%）且最终治愈2例;通过TEM切开狭窄治愈2例（2.5%）;经腹吻合口切除后肠管再吻合治愈2例（2.5%）。治疗总成功率为70.0%（56例）,30.0%（24例）治疗失败患者中：58.3%（14/24）为弥漫性狭窄,41.7%（10/24）为管状狭窄,无膜性狭窄患者;75%（18/24）发生过吻合口漏;75.0%（18/24）属于低位狭窄,75.0%（18/24）并发盆腔感染,最终造口还纳失败,被迫接受永久造口。治疗失败者当中吻合口漏、非膜性狭窄、良性隐匿型狭窄、盆腔感染明显多于治愈者,两组患者差异有统计学意义（均P<0.05）。治疗过程没有死亡病例。 结论直肠癌术后良性吻合口狭窄首选治疗方法为肛门指检、内镜治疗手段,可获得较好治疗效果;治疗失败者与吻合口漏、非膜性狭窄、良性隐匿型狭窄、盆腔感染等相关,临床工作中理应重视这些并发症,提早预防。     

Magnetic compression anastomosis for rectal atresia following necrotizing enterocolitis: A case report

Rationale:Rectal atresia caused by necrotizing enterocolitis (NEC) is a serious and rare complication in children. Magnetic compression anastomosis (MCA) has been effectively applied in children with congenital oesophageal atresia and biliary atresia. Herein, we reported a case of successfully application of MCA in an infant with rectal atresia following NEC.Patient concerns:A 30⁺⁶ weeks premature birth female fetal infant was transferred to our neonatal intensive care unit due to premature delivery, low birth weight, and neonatal respiratory distress. On postpartum day 11, the infant developed abdominal distension and mucosanguineous feces. This infant was then clinically diagnosed as NEC. She underwent anesthesia and intestinal fistula operation on postpartum day 11 because of NEC.Diagnosis:After 3 months, radiographic examination revealed rectal atresia and stricture.Interventions:This infant was successfully treated with MCA following a cecum-rectal anastomosis and ileocecal valve was reserved.Outcomes:On postoperative day 9, she passed the 2 magnets per rectum. In addition, there were no difficult defecation or fecal incontinence or other short-term complications. After the 7-month follow-up, the patient had an excellent clinical outcome.Lessons:MCA is a feasible and effective method for treating rectal atresia in infants.     

Comparison between the biofragmentable anastomosis ring and stapled anastomoses in the extraperitoneal rectum: a prospective, randomized study

Serious complications can be carried by intestinal anastomoses, particularly in the distal and proximal part of the gastrointestinal tract. The biofragmentable anastomosis ring (BAR) has been shown to be a safe anastomotic technique, but its clinical applicability in the extraperitoneal rectum has not yet been completely established. This study compared BAR anastomoses and stapled anastomoses in the middle rectum. Thirty-six consecutive patients initially suitable for elective colorectal anastomosis in the middle rectum were enrolled into this study. All patients had intraperitoneal rectum carcinoma, and 31 underwent a colorectal anastomosis in the middle extraperitoneal rectum. They were randomly allocated to a stapled technique or BAR anastomosis. Intraoperative findings and technical drawbacks, tumor behavior, and postoperative course were recorded. All patients were followed up, and late stenosis rate was investigated by endoscopy. The procedure was carried out in each of the 15 patients randomized to receiving a BAR anastomosis. No major difficulties were encountered, and the time needed was even less than that required for a stapled anastomosis. One patient in the stapled group had an early bleeding that required a further laparotomy. No significant differences in postoperative complications were noted between the two groups, although one patient with stapled anastomosis experienced a clinical leakage that needed loop colostomy. Biofragmentability was regular; buttons were eliminated in 3weeks without any bowel disturbance. BAR ring insertion in the deep pelvis did not produce a shorter colonic resection. The late stenosis rate was similar between the groups. This study shows that in extraperitoneal middle rectum BAR anastomosis is as feasible and safe as the stapled method. The latter is more expensive, and manual suture is more difficult. Therefore the BAR is now the method of choice for this anastomosis in the authors’ unit. Accepted: 14 October 1999     

Magnetic compression anastomosis for the stricture of the choledochocholedochostomy after ABO-incompatible living donor liver transplantation

Biliary complications, such as stricture or obstruction after living donor liver transplantation (LDLT), are still major problems. Magnetic compression anastomosis (MCA) is a minimally invasive and nonsurgical procedure in patients with biliary structure or obstruction. A 49-year-old woman who had had ABO-incompatible LDLT 16 months previously presented with obstructive jaundice. After sufficient improvement of obstructive jaundice by percutaneous transhepatic cholangiodrainage (PTCD), the rendezvous technique between PTCD and endoscopic retrograde cholangiopancreatography was attempted in order to break through the stricture, but this was not successful. Therefore, MCA was performed. A parent magnet was endoscopically placed at the common bile duct side of the stricture, and the daughter magnet, attached to a guidewire, was also inserted to the intrahepatic bile duct. Both magnets were advanced to positions immediately prior to the biliary obstruction, and it was confirmed that the two magnets attracted each other magnetically, sandwiching the stricture. Twenty-four days after MCA, as recanalization could be achieved without any adverse events, the magnets were removed via the PTCD fistula. MCA enabled us to create a fistula without complications. In conclusion, when a conventional endoscopic or percutaneous approach, including the rendezvous technique, has failed, MCA is a novel method for patients with the stricture of the choledochocholedochostomy after LDLT.     

基于钕铁硼磁磁压榨技术在肠道吻合中的动物实验研究

目的通过建立家兔结肠的磁压榨吻合模型,验证磁压榨吻合技术在结肠压榨吻合的可行性,并评估压榨吻合口的粪便转流功能。 方法选取8只家兔,在结肠置入一定规格的磁铁实现肠道的侧侧压榨吻合,吻合口形成后,通过结肠造影、解剖观察及病理检查的方法评估吻合口的形成情况。人为结扎吻合口之间的肠道制造肠梗阻动物模型,评估压榨吻合口的粪便转流功能。 结果8只家兔均在术后第6~8天磁铁脱出;1只家兔发生肠梗阻,其余7只家兔吻合口形成良好。吻合口形成后,取3只家兔结扎吻合口之间肠道,1只家兔于术后第6天死亡,其余2只家兔长期存活,实现了压榨吻合口的粪便转流功能。 结论磁压榨吻合技术能够实现家兔肠道的吻合,是一种有效的手术方式。     

Coloplasty in low colorectal anastomosis

PURPOSE: After resection of the distal rectum with a straight reanastomosis, poor bowel function can occur. This is felt to be because of the loss of the rectal reservoir. To overcome this, a neoreservoir using a colonic J-pouch has been advocated in low colorectal and coloanal anastomosis. However, difficulties in reach, inability to fit the pouch into a narrow pelvis, and postoperative evacuation problems can make the colonic J-pouch problematic. Coloplasty is a new technique that may overcome the poor bowel function seen in the straight anastomosis and the problems of the colonic J-pouch. The purpose of this study was to compare the functional results after a low colorectal anastomosis among patients receiving a coloplasty, colonic J-pouch, or straight anastomosis. METHODS: Twenty patients underwent construction of a coloplasty with a low colorectal anastomosis. Postoperative manometry and functional outcome of these patients was compared with a matched group of 16 patients who had a colonic J-pouch and low colorectal anastomosis and 17 patients who had a straight low colorectal anastomosis. RESULTS: Maximum tolerated volume was significantly favorable in the coloplasty (mean, 116.9 ml) and colonic J-pouch group (mean, 150 ml) vs. the straight anastomosis group (mean, 83.3; P < 0.05) The compliance was also significantly favorable for the coloplasty (mean, 4.9 ml/mmHg) and the colonic J-pouch group (mean, 6.1 ml/mmHg) vs. the straight anastomosis group (mean, 3.2 ml/mmHg; P < 0.05) The coloplasty (mean, 2.6; range, 1-5) and colonic J-pouch (mean, 3.1; range, 2-6) had significantly fewer bowel movements per day than the straight anastomosis group (mean, 4.5; range, 1-8; P < 0.05). Similar complication rates were noted in the three groups. CONCLUSIONS: Patients with a coloplasty and low colorectal anastomosis seem to have similar functional outcome along with similar pouch compliance compared with patients with colonic J-pouch and low colorectal anastomosis. However, the coloplasty may provide an alternative method to the colonic J-pouch for a neorectal reservoir construction when reach or a narrow pelvis prohibits its formation. Technically it also may be easier to construct.     

Magnetic compression anastomosis for biliary obstruction: review and experience at Tokyo Medical University Hospital

Background

Magnetic compression anastomosis (MCA) is a revolutionary, minimally invasive method of performing choledochoenterostomy or choledochocholedochostomy without using surgical techniques in patients with biliary stricture or obstruction. Herein, we describe a case series of MCA for severe biliary stricture or obstruction, which could not be treated with conventional therapies.

Patients and methods

Two patients with biliary obstruction were treated using MCA for choledochocholedochostomy and choledochoenterostomy at Tokyo Medical University Hospital and Tokyo Medical University Hachioji Medical Center. Endoscopically, a samarium?Ccobalt (Sm?CCo) rare-earth magnet was placed at the superior site of obstruction through the percutaneous transhepatic biliary drainage route and another Sm?CCo magnet was placed at the inferior site of obstruction. A comprehensive computer-aided literature search for MCA was performed up to September 2009 by using MEDLINE and EMBASE.

Results

MCA techniques enabled complete anastomosis in both cases without procedure-related complications.

Conclusions

The MCA technique is a revolutionary method of performing choledochocholedochostomy and choledochoenterostomy interventionally in patients with biliary obstruction, for whom the conventional endoscopic procedure is not available, or in candidates who are deemed unsuitable for surgery.     

颈动脉狭窄和闭塞患者空间工作记忆的功能磁共振成像研究

目的探讨左侧颈内动脉、大脑中动脉狭窄和闭塞患者与正常人空间工作记忆的激活脑区差异。方法选择左侧颈动脉狭窄和闭塞患者10例(病例组),其中左侧颈内动脉狭窄4例,左侧颈内动脉闭塞2例,左侧大脑中动脉狭窄3例,左侧大脑中动脉闭塞1例,另选健康体检者20例(对照组),对病例组和对照组进行空间记忆任务的功能磁共振成像,采用AFNI软件进行分析。结果病例组空间位置记录正确率较对照组明显降低[(79.2±16.5)%vs(88.6±11.8)%,P<0.05]。对照组空间工作记忆的编码期、保持期、提取期脑激活明显强于病例组。结论左侧颈动脉狭窄和闭塞患者空间记忆任务的脑激活区存在损害,功能磁共振成像研究能为早期诊断认知障碍提供影像学依据。     

Stapled anastomosis in colorectal surgery

The authors review their experience with stapled anastomosis in colorectal and ileorectal resections for malignant and benign lesions of the large bowel. They describe the technique and results in a series of 49 patients (24 with cancer of the rectum and rectosigmoid junction; six with familial polyposis, associated with cancer in four; 12 with chagastic megacolon; three, Crohn’s disease; two, ulcerative colitis; and one each, diverticular sigmoiditis and ischemic sigmoiditis). Anterior resection was performed in 38 patients and total colectomy with ileorectal anastomosis in 11. Main complications and mortality are presented. They conclude that stapled anastomosis is an efficient method for intestinal reconstruction after resection for malignant and benign lesions of the large bowel     

Rectal tube decompression of left-colon anastomosis

Summary and Conclusion In a series of 153 consecutive patients who underwent left-colon or colorectal anastomosis, an indwelling rectal tube was introduced through the anastomosis to provide postoperative decompression. In all instances the results were satisfactory. It eliminated the need for a proximal colostomy or cecostomy in the “difficult” or “questionable” anastomoses. Contrary to popular belief, there were no stomal complications attributable to the use of the rectal tube. In fact, complications were fewer than those encountered in other reported series in which a tube was not used. Introduction of a rectal tube through an anastomosis, after left-colon and colorectal anastomosis, is a safe and efficient method of providing decompression of the proximal portion of the colon. Furthermore, reinforcement of the anastomosis and removal of tension can be accomplished without fear of angulation. Adequate size of the stoma is assured. An avenue is provided for introduction of local antibiotic agents with which to bathe the suture line. Read at the meeting of the American Proctologic Society, Denver, Colorado, June 10 to 13, 1968.     

Direct atriopulmonary anastomosis (modified Fontan) for single ventricle and its equivalents

The modified Fontan procedure is being used in an increasing number of complex cyanotic cardiac lesions with pulmonary stenosis. Seven patients aged 11 to 24 years (average 17.5 years) underwent surgery by a technique derived from the Fontan procedure: direct atriopulmonary anastomosis without a tube or valve. The tricuspid valve when patent was closed with a patch. The diagnoses were: single ventricule (4 cases), Taussig-Bing anomaly (2 cases) and tricuspid atresia (1 case). All patients had associated pulmonary stenosis with low pulmonary vascular resistances. The great vessels were in L-malposition in 3 cases. The hospital mortality was nil. Transient atrial fibrillation was observed in 2 cases and was well tolerated clinically. The follow-up period ranges from 2 months to 4 years (average 2.3 years). All patients are acyanotic with no signs of right-sided failure and in sinus rhythm. Control cardiac catheterisation and angiography were performed in 6 cases and showed good function of the anastomosis and a mean atrial pressure of 14 mmHg. Direct atriopulmonary anastomosis offers a very acceptable surgical solution to certain forms of single ventricle or equivalent with low pulmonary pressures. The short and medium term results seem to be better than those of intraventricular repair.