金属夹腔内闭合人造肠穿孔的实验研究  

Endoscopic intraluminal closure of colon perforation with metal clip： a study in porcine model

作　　者：袁庆丰[1] 张啸[1] 张筱凤[1] 吕文[1] 杨建锋[1] 周益峰[1] 范震[1] 徐鸿[1] 蒋祯[1] 

机构地区：[1]浙江省杭州市第一人民医院消化科,310006

出　　处：《中华消化内镜杂志》2011年第6期326-329,共4页Chinese Journal of Digestive Endoscopy

基　　金：杭州市科技发展计划重点项目（20080333Q01）

摘　　要：目的探讨内镜下金属夹腔内夹闭行肠穿孔修补术的安全行和可行性。方法对4头巴马小型猪进行长约2 cm的肠全层穿孔造模。1头未行修补术，作对照；其余3头采用三爪和二爪金属夹各2枚闭合，其中1头在金属夹闭合创I：1后表面注射纤维蛋白胶。4头均在术后第14天处死，行大体标本观察、亚甲蓝渗漏试验、腹腔液细菌培养和病理学检查。术后2周内观测和记录4头猪的体温、白细胞等一般情况变化，并行分类比较。结果4头猪均成功完成了肠穿孔造模术。3头猪内镜下肠穿孔修补术均获成功，术后2周内体温、血白细胞计数均较对照猪明显降低或减少（P〈0．05），一般情况更好。解剖后大体标本显示，对照猪肠创口未完全闭合，周围有多处粘连，病理示全层缺损；2头行金属夹闭合术的猪，肠创口完全闭合，病理示基本修复，腹腔内未见明显粘连现象；1头行金属夹联合注射纤维蛋白胶的猪，肠创口周围有多处粘连，病理示不完全修复。结论内镜下对直径2 cm大小的肠穿孔行金属夹闭合的方法安全可行，可有效修复创口，但联合使用纤维蛋白胶对闭合创口是否具有优势尚需进一步的实验证实。Objective To evaluate the feasibility and safety of endoscopic intraluminal closure of small colon perforation with metal clips in porcine model. Methods A 2 cm full-thickness colon perforation was made in 4 bama mini-pigs. One did not receive local closure as a control, while 3 others underwent closure with bi- and tri-arm clips, one of which received additional fibrin glue injection after closure. Necropsy was done on day 14 after the procedure, and dye leak test, peritoneal fluid bacteria culture and histologieal examination were performed. During the 2 week observation period, the body temperature and blood leukocytes count were recorded and compared. Results Endoscopic closure of the colon perforation was technically successful in all 3 pigs. The body temperature and blood leukocyte count of these pigs were both lower than those of the control. Necropsy showed that the perforation in control pig was not completely closed and with multiple adhesions around. Perforation complete closure and pathological healing without adhesion were observed in 2 pigs with clip closure only, while adhesion and incomplete pathological healing was detected in the other one with clip closure plus fibrinogen injection （P 〈 0. 05）. Conclusion Endoscopic intraluminal closure of a 2 cm colon perforation with metal clips is feasible and safe, while further study is needed to evaluate the effect of combined local fibrinogen injection.

关 键 词：肠穿孔 猪 经内镜修补术 金属夹 

分 类 号：R656.7[医药卫生—外科学]