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1.
目的:研究一种能高效完成大动脉吻合的新型血管吻合器械,利用磁性吻合技术(MCA)达到快速吻合大动脉的目的。方法:选择成年杂种犬16只,按随机数字表法分为两组:MCA组( n=8),利用新型磁吻合器械完成吻合;传统手工缝合(HS)组( n=8)。比较两种方法吻合腹主动脉耗时、吻合口耐压水平、术中渗...  相似文献   

2.
目的  探讨利用磁压榨吻合(MCA)技术实现犬腹主动脉人工血管置换快速无缝线吻合的可行性。方法  选择成年健康杂交犬12只,按腹主动脉与人工血管吻合方式分为MCA组和手工缝合(HS)组,每组6只。比较两组术中腹主动脉阻断时间、术中吻合口情况与术后吻合口影像学检查情况。结果  MCA组腹主动脉阻断时间短于HS组[(5.2±2.3)min比(24.4±4.3)min],差异有统计学意义(P < 0.001)。MCA组术中吻合口无渗漏血及狭窄情况发生;HS组术中6只犬均发生吻合口渗漏血,其中1只犬因失血过多死亡,2只犬因反复修补而出现吻合口轻度狭窄。MCA组术后彩色多普勒超声与血管造影检查显示吻合口血流通畅,无狭窄及血栓形成,HS组术后4周时血管造影检查共发现4只犬吻合口狭窄。结论  利用MCA技术可实现犬腹主动脉人工血管置换快速无缝线吻合,减少吻合口并发症的发生,有利于术后恢复。  相似文献   

3.
杨丽斐  吕毅 《器官移植》2017,8(3):181-185
肝移植是终末期肝病唯一有效的治疗手段。虽然移植器官保存技术、免疫抑制剂及外科手术的不断进展在很大程度上提高了肝移植成功率,但是术中传统的手工缝合血管的方法,易引起器官缺血-再灌注损伤、血管狭窄等并发症,导致患者生存质量下降。研制并发明一种能高效完成血管无缝线吻合的新型血管吻合器,利用磁压榨吻合技术达到血管快速吻合的目的,最终得以实现肝移植术中肝脏附属管道无缝线快速重建,尽可能地降低手术难度、缩短无肝期、减少手术并发症发生率。全面、深入、系统地研究磁吻合技术的基础理论和临床应用的可行性、安全性,可促进血管吻合重建技术的临床转化应用。  相似文献   

4.
目的利用磁吻合技术(magnetic compressive anastomosis,MCA)进行肝脏附属大血管快速重建,研究离体肝部分切除后实现肝脏快速植入可行性。方法选择成年杂种犬15只,离体肝脏部分切除后进行原位肝脏植入,按肝脏附属大血管吻合方法不同,随机数字表法分为2组:MCA组(n=10),利用新型复合材料磁吻合环快速重建肝上、肝下下腔静脉(inferior vena cava,IVC)及门静脉(portal vein,PV);传统缝合(traditional handsewing,THS)组(n=5),采用传统手工缝合方法完成肝脏附属血管吻合。记录静脉吻合时间及吻合口渗漏情况、术中与术后生存时间,彩色多普勒超声与血管造影检查吻合口血流及并发症情况。结果 MCA组术中死亡1例,存活9只,肝上、下IVC及PV吻合耗时(9.5±2.5) min较THS组(30.7±3.4) min明显缩短(P=0.000);无肝期比较差异有统计学意义(P=0.000);MCA组术中吻合口无渗漏血发生,肝脏植快速植入后血流动力学稳定,THS组5只犬于术中全部死亡。术后血管X线造影与彩色多普勒超声检...  相似文献   

5.
磁压榨吻合技术极大改善了传统吻合的效率和效果,是磁外科技术的重要组成部分,其安全性和可行性已在动物实验和临床中得到验证,现已广泛用于胃肠、肝胆胰、食管、血管等,形成了磁压榨胃肠吻合、空肠吻合、胆肠吻合、食管吻合、血管吻合等。追踪其在外科手术中用于吻合重建的情况,对于未来的发展具有重要的意义。  相似文献   

6.
目的探讨基于磁压榨技术设计的磁吻合环在食管吻合重建中的可行性。方法根据SD大鼠食管解剖特点自行设计食管磁吻合环。以SD大鼠为动物模型(n=10,雌雄各半),利用磁吻合环完成颈段食管的磁吻合重建,记录手术操作时间、动物生存情况、术后并发症、磁环排出时间等。术后2周处死动物,获取食管吻合口标本,测量吻合口爆破压、肉眼观察吻合口形成情况。结果对10只SD大鼠均成功实施了食管磁吻合重建,中位吻合时间11(8~13)min,术后所有大鼠均存活良好,未见吻合口瘘、吻合口狭窄、磁环崁顿等。磁环中位排出时间为8(5~10)d。吻合口爆破压300 mm Hg以上。肉眼观察吻合口肌层愈合良好,黏膜层光滑平整。结论磁压榨技术可用于食管吻合重建,具有操作简单、吻合效果可靠等优点,具有临床应用前景。  相似文献   

7.
磁吻合作为一种创新的外科微创技术,在消化道重建领域展现出卓越的吻合效果。该技术通过微创的手段,使用内镜或其他方式将磁体置入消化道梗阻部位远近端,通过磁体间吸引压迫作用使受压组织坏死脱落,从而恢复消化道的连续性。目前,磁吻合技术主要应用于食管、胆管、胃肠等空腔器官的吻合,尤其在病情复杂的消化道手术中展现出独特优势,通过磁场作用力将消化道管腔的狭窄、闭锁或两消化道端端相互吸引并连接,实现消化道的重建。相较于传统手术,磁吻合技术具有创伤小、操作简便和并发症少等优势,为消化道重建提供了一种可靠的吻合方式。  相似文献   

8.
目的:探讨磁吻合技术在腹腔镜胰十二指肠切除术(laparoscopic pancreatoduodenectomy,LPD)中应用的可行性和安全性。方法:回顾分析2018年5月至2019年9月于西安交通大学第一附属医院肝胆外科接受LPD+磁吻合消化道重建的7例患者资料,其中男性6例,女性1例,患者中位年龄63(56~8...  相似文献   

9.
目的 通过磁性压榨式吻合技术(MCA)实现腹腔大血管无缝线吻合的组织学与电镜观察,比较新型血管吻合器较传统手工缝合方法的优点.方法 杂种犬16条,随机分为MCA组与手工缝合组,统计两组下腔静脉(IVC)吻合时间,观察吻合即刻、吻合后4、12、24周两组犬IVC吻合口愈合情况;血管吻合口苏木素-伊红染色(HE)与Masson三色染色用于组织学分析;扫描电镜观察吻合口内皮细胞连续性和生长情况.结果 MCA组IVC吻合时间较手工缝合组明显缩短[(3.25±1.21) min比(13.23±2.34) min,P<0.01].电镜观察:MCA组吻合口内膜光滑,内皮细胞排列整齐,形态规则,但手工缝合组吻合口因缝线牵拉导致管腔内凹凸不平,内膜不完整,吻合口内皮细胞排列紊乱,形态不规则;组织学检查:MCA组吻合口血管壁对位整齐,血管内膜覆盖吻合口,术后12周吻合口呈慢性炎性反应,少量淋巴细胞浸润,24周无明显炎性反应,但手工缝合血管吻合口有明显缝线异物残留与瘢痕形成.结论 MCA组较手工缝合组手术耗时少,血管壁各层衔接较好,内皮细胞层光滑,无明显增生,血管腔无异物残留,吻合口炎性反应轻微.MCA血管吻合技术实现IVC无缝线吻合效果可靠.  相似文献   

10.
目的  研制一种适用于大鼠肝下下腔静脉的磁性吻合装置并验证其可行性及安全性。方法  根据大鼠下腔静脉解剖特点,设计并加工了一种适用于大鼠肝下下腔静脉端端吻合的磁性装置,该装置分为内环和外环两个部分,内环为具有镀层的钕铁硼磁环,外环由聚醚醚酮经3D打印制成,其上均匀分布10个细孔,其中5个细孔用于加载细针,另外5个细孔在吻合时与对侧吻合环的细针相互嵌合。将外环上均匀加载细针后与内环粘接在一起组成磁性吻合环,将两侧血管断端穿过吻合环后外翻固定至细针上,再将两侧磁性吻合环相吸便完成血管吻合。选取20只SD大鼠利用磁性吻合装置进行肝下下腔静脉端端磁吻合,分析大鼠术中血管阻断时间、术后存活情况、术后吻合口通畅情况和术后吻合口大体观及组织学检查情况。结果  所有大鼠均顺利完成大鼠肝下下腔静脉端端磁吻合,血管阻断时间为4~6 min。其中1只大鼠在术后10 d死亡,其余大鼠均存活至术后2个月。存活大鼠术后1 d、3 d、1个月及2个月血管吻合口通畅率分别为100%、100%、95%及95%。术后2个月时血管吻合装置未发现明显移位、成角,血管吻合环未发现明显腐蚀、裂解迹象,周围组织未见明显增生及水肿,两侧血管断端已完全愈合,吻合口未见明显狭窄及血栓形成。组织学检查发现吻合口两侧血管管壁连续性良好,吻合口内面可见内皮细胞覆盖,未见血栓及纤维组织附着。结论  利用本研究设计的磁性吻合装置施行大鼠肝下下腔静脉端端磁吻合是安全可行的。  相似文献   

11.

Background

Portal vein thrombosis (PVT) or stenosis (PVS) often requires challenging techniques for reconstruction in living donor liver transplantation (LDLT).

Materials and Methods

A total of 57 LDLTs were performed between October 1996 and December 2010. There were 16 cases (28%) with PVT/PVS that underwent modified portal vein anastomosis (m-PVa). The m-PVa techniques were classified into 3 groups: patch graft (Type-1), interposition graft (Type-2), and using huge shunt vessels (Type-3). The reconstruction patterns were evaluated with regard to age, graft vessels, PV flow, and complication rate.

Results

The m-PVas were Type-1 in 10 cases, Type-2 in 3 cases, and Type-3 in 3 cases. The vessel graft in Type-1 was the inferior mesenteric vein (IMV) in 8 and the jugular vein in 2 cases, whereas the vessel graft in Type-2 was IMV in 2 and the saphenous vein in 1 case; in Type-3, the vessel grafts were renoportal, gonadal-portal, and coronary-portal anastomoses, respectively. The postoperative PV flow was sufficient in all types and slightly higher in Type-3. The postoperative complications occurred in 20% of the patients who underwent Type-1, in 33% who underwent Type-2, and in 0% who underwent Type-3.

Conclusion

The m-PVa was effective to overcome the surgical difficulty during transplantation. Pretransplant planning for the selection of the type of reconstruction is important for recipients with PVT/PVS.  相似文献   

12.
目的 检测犬门静脉压力与胃黏膜原位末端标记(TUNEL)染色测凋亡指数(AI值)及多克隆抗体Caspase-3行免疫组织化学计算各染色强度细胞评分总和(H值),探讨门静脉压力与门静脉高压性胃病( PHG)的相关性.方法 本地杂种犬32条,采用一期门静脉缩窄法制备犬门静脉高压症动物模型,术中及术后14周后开腹测量门静脉压力及取胃组织标本,测胃黏膜AI值及H值.结果 术后14周门静脉压力和AI值行直线回归分析得回归系数b=0.5799,常数项a=3.3064,两者呈正线性相关(r=0.8079,P<0.01).术后14周门静脉压力和H值行直线回归计算得回归系数b=2.6277,常数项a=6.7828.相关分析得相关系数r=0.7960,P<0.01,可以认为两者呈正线性相关.结论 PHG与门静脉压力呈正线性相关,治疗PHG的关键在于降低门静脉压力.  相似文献   

13.

Background

Magnetic compression technology is a safe and convenient digestive tract reconstruction technique in large animals. The purpose of this study was to verify the feasibility of using the micromagnetic ring for construction of small intestinal end-to-side anastomosis in rats.

Methods

Thirty male Sprague–Dawley albino rats were randomly divided into two groups: a study group that underwent small intestinal anastomosis with micromagnetic ring and a control group that had hand-sewn anastomosis. The time to construct the anastomosis, survival rate and incidence of complications were compared between the two groups. The anastomotic segments in each group were harvested on day 28 after surgery and investigated.

Results

The mean anastomosis construction time was significantly lower in the study group than the control group (6.80?±?1.97?min vs. 16.13?±?3.29?min, P?<?0.05). The survival rate was significantly higher in the study group (93.3%, 14/15) than the control group (66.7%, 10/15; P?<?0.05). The incidence of anastomotic leakage [0% (0/15) vs. 6.67% (1/15), P?=?1.000] and obstruction [20% (3/15) vs. 13.33% (2/15), P?=?0.330] was similar in the study group and control group. The mean burst pressure did not differ significantly between the magnetic compression and hand-sewn anastomosis. In the study group, alignment of the tissue layers was improved and the inflammatory reaction was milder.

Conclusion

Use of a micromagnetic ring for small intestinal end-to-side anastomosis in rats is safe and feasible.  相似文献   

14.
磁性压榨吻合是通过磁性吻合器之间的相互吸引将欲吻合管道组织压在一起、实现组织连续性重建的方法。通过磁环、磁柱加磁环和整套磁体3个阶段的发展和创新,目前磁性压榨吻合已经在血管和各种消化道吻合中应用,并成功解决了多种复杂胆道梗阻和食管狭窄等的再吻合。尽管国内外学者在磁性压榨吻合的应用研究方面做过不少的探索,但限于目前的研究多属个案报道形式,其操作的标准化程度较差,经验不易复制。我们期待磁性压榨吻合技术引起业内更多学者的关注,开发这项技术研究的基础数据库,搭建一系列磁性吻合研究所需的技术平台,出台一整套磁性压榨吻合的使用规范和效果评价体系,全面推进磁性压榨吻合技术的推广和应用,造福广大患者。  相似文献   

15.
目的 应用磁压榨吻合的原理,探索一种新的肠漏一期修补的方法.方法 将24只犬在距Treitz韧带50、100 cm处空肠分别横行切开肠壁约1 cm,建立犬高位、多处肠漏模型,按随机数字表法分为实验组和对照组,每组12只,观察犬肠漏模型的建立情况.肠漏形成48 h后,实验组采用磁通量为2500 G的钕铁硼磁环原位压榨修补漏口,对照组采用丝线缝合修补漏口.观察犬的一般情况,测吻合口渗漏压,肉眼观察吻合口情况并切取吻合口组织行HE和Masson染色,实验组加行X线检查观察磁环位置并记录磁环排出体外的时间.采用两样本t检验分析检测结果.结果 肠漏模型建立48 h后出现严重的腹腔感染.实验组犬肠漏修补全部获得成功,动物能长期存活,磁环在肠漏修补术后6~7 d排出体外;对照组犬存活8只.肠漏修补术后7 d,实验组与对照组犬吻合口渗漏压分别为(134±23)mm Hg(1 mm Hg=0.133 kPa)和(91±18)mm Hg,两组比较,差异有统计学意义(t=3.225,P<0.05);肠漏修补术后14 d,实验组与对照组犬吻合口渗漏压分别为(281±7)mm Hg和(271±21)mm Hg,两组比较,差异无统计学意义(t=0.988,P>0.05).磁环原位压榨修补后肠道的浆肌层和黏膜层愈合良好,吻合口周围炎症反应轻微,胶原纤维含量少,瘢痕增生不明显.结论 在腹腔感染状态下,应用磁通量为2500 G的磁环对犬肠漏进行一期修补是安全可靠的.
Abstract:
Objective To explore a new method for one-stage repair of the intestinal leakage based on the principle of magnetic compression anastomosis. Methods Twenty-four dogs were randomly divided into experimental group (n = 12) and control group (n = 12) according to random number table. The model of upper and multiple intestinal leakages was established by making transverse incisions of 1 cm in length on the jejunum wall about 50 cm and 100 cm away from the Treitz ligament. Forty-eight hours later, two NdFeB magnetic rings with the magnetic flux of 2500 G were put into the intestine from the leak sites. The leak sites were pressed between the two rings. The ventages in the control group were sutured. The condition of the dogs was observed after the repair of the leakage. The excreting time was recorded, and the leakage pressures of the anastomotic stoma were detected.The positions of the magnetic rings in the experimental group were detected by X ray. Tissues of the anastomotic stoma were processed by hematoxylin eosin and Masson staining. All data were analyzed using the two-sample t test. Results Severe abdominal infection occurred 48 hours after the establishment of the model. All the intestinal leakages in the experimental group were successfully repaired and the dogs survived for a long time. The magnetic rings were excreted six or seven days after the repair. Eight dogs of the control group survived. The leakage pressure of the anastomotic stoma seven days after the repair was (134 ±23)mm Hg (1 mm Hg =0. 133 kPa) in the experimental group and (91 ± 18)mm Hg in the control group, respectively, with a significant difference between the two groups (t = 3.225, P < 0.05). The leakage pressure of the anastomotic stoma 14 days after the repair was (281 ±7)mm Hg in the experimental group and (271 ±21) mm Hg in the control group, respectively, with no significant difference between the two groups (t =0. 988, P > 0.05). Histological observation showed that after the magnetic compression anastomosis, the intestinal muscle and mucosa recovered well, inflammatory reaction was slight and less collagen fiber and scar was formed. Conclusions Application of magnetic ring with the magnetic flux of 2500 G in one-stage repair of the intestinal leakage in the state of severe abdominal infection is safe and reliable.  相似文献   

16.

Background

Extrahepatic portal vein obstruction (EHPVO) has been associated with growth impairment in children. We hypothesized that growth parameters improve after reversal of portal hypertension and restoration of mesenteric venous blood flow to the liver by the mesenterico-left portal vein bypass (MLPVB).

Methods

A retrospective review of 45 children with idiopathic EHPVO who underwent MLPVB between 1997 and 2007 and had follow-up data for analysis was carried out. Growth was assessed using SD scores (z scores) for height, weight, and body mass index (BMI) at the time of operation and at early (5-12 months) and late (13-24 months) follow-up.

Results

The mean height and weight of children with EHPVO was significantly lower than the general population before surgery. Mean BMI was also lower, although statistically insignificant. All parameters increased significantly after MLPVB as follows: height from −0.42 before surgery to −0.12 (P = .027) at 5 to 12 months and −0.14 (P = .026) at 13 to 24 months; weight from −0.49 before surgery to 0.03 (P < .001) at 5 to 12 months and 0.35 (P < .001) at 13 to 24 months; and BMI from −0.22 before surgery to 0.17 (P = .001) at 5 to 12 months and 0.48 (P < .001) at 13 to 24 months.

Conclusion

Restoration of portal blood flow to the liver by MLPVB improves growth in children with EHPVO.  相似文献   

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