可降解防返流食管胃吻合支架的研制及体内实验研究  

Development of biodegradable anti-reflux esophagogastric anastomosis stent and its preliminary animal study

作　　者：张智强[1] 王文利[1] 赵航[1] 卢天成 吴凯钦 周永新[1] ZHANG Zhi-qiang;WANG Wen-li;ZHAO Hang;LU Tian-cheng;WU Kai-qin;ZHOU Yong-xin(Dept. of Cardiothoracic Surgery, Tongji Hospital, Tongji University, Shanghai 200065, China)

机构地区：[1]同济大学附属同济医院胸心外科,上海200065

出　　处：《同济大学学报（医学版）》2018年第6期54-59,共6页Journal of Tongji University(Medical Science)

基　　金：上海市卫计委重点项目(201540371)

摘　　要：目的研制用于食管切除后食管胃吻合的可降解防返流吻合支架,经初步体内实验研究,了解其降解特性及行食管胃吻合的可行性。方法根据目前食管胃吻合支架研究存在的问题,采用3D打印技术将聚乳酸材料制作成1种可降解防返流食管胃吻合支架,在支架内采用牛心包缝制防返流瓣膜。经体外模拟胃酸环境降解实验了解支架体外降解特性,采用家猪6只,行经腹食管下段贲门切除及食管胃支架吻合术,经术中及术后观察食管胃支架吻合的可行性及安全性。结果食管胃吻合支架体外胃酸环境降解实验显示支架16周内逐步降解,降解速度较慢。6只家猪均成功完成支架吻合,术后早期进食,无需胃管引流,观察4周吻合口愈合好,无吻合口瘘及狭窄,但1例术后出现幽门梗阻,4周后处死解剖该例发现吻合支架仍部分残留胃腔内,其余几例胃腔内均未见支架。结论研制的可降解防返流吻合支架在食管胃吻合中使用具有操作快捷,吻合确实,具有术后早期进食,无需胃管引流等优点,但吻合支架仍降解过慢,存在幽门梗阻的风险,有待进一步改进。Objective To develop a biodegradable anti-reflux stent used for the esophagogastric anastomosis after esophagectomy.Methods A biodegradable anti-reflux stent was designed and developed by3D printing technology using polylactic acid(PLA)materials.Anti-reflux valve was prepared inside the stent with bovine pericardium.The in vitro degradation characteristics of the stent was determined by bioremediation experiment in the in vitro simulated gastric acid environment.The cardiectomy at the lower segment of the esophagus and esophagogastric anastomosis were performed in6pigs.The feasibility and safety of the esophagogastric anastomosis stent were observed during and after the operation.Results The valve stent was successfully developed by3D printing technology.The biodegradation experiment in vitro showed that the stent was gradually degraded within16weeks with a slow speed.The in vivo experiments showed that the early postoperative eating needed not gastric tube drainage in the pigs.The healing of the anastomotic was good after4weeks without anastomotic fistula or stenosis,however,1patient had pyloric obstruction after the operation and the stent residues were still in the gastric cavity after4weeks.Conclusion The developed biodegradable anti-reflux anastomosis stent has the advantages of simple and quick operation,definite anastomosis and early feeding without gastric tube drainage.However,the degradation of the anastomosis stent is slow at the risk of pyloric obstruction,and further improvement is needed.

关 键 词：支架 食管切除 食管胃吻合 可降解 家猪 

分 类 号：R655.4[医药卫生—外科学]