磁力疏通技术在术后消化道狭窄中的应用  

Magnetic recanalization technique for the treatment of alimentray tract stricture: A clinical study

作　　者：李宇[1,2,3] 苏茂生[4] 孙学军[5] 于良[1] 刘昌[1] 和水祥[6] 吴荣谦[2,3] 孙昊[1] Yu Li;Maosheng Su;Xuejun Sun;Liang Yu;Chang Liu;Shuixiang He;Rongqian Wu;Hao Sun(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;National Local Joint Engineering Research Center for Precision Surgery&Regenerative Medicine,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Department of Hepatobiliary Surgery,Chinese PLA General Hospital,Beijing 100853,China;Department of General Surgery,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Department of Digestive Medicine,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院肝胆外科,西安710061 [2]西安交通大学第一附属医院精准外科与再生医学国家地方联合工程研究中心,西安710061 [3]西安交通大学第一附属医院陕西省再生医学与外科工程研究中心,西安710061 [4]解放军总医院肝胆外科,北京100853 [5]西安交通大学第一附属医院普外科,西安710061 [6]西安交通大学第一附属医院消化科,西安710061

出　　处：《科学通报》2020年第13期1283-1294,共12页Chinese Science Bulletin

基　　金：国家自然科学基金(81470896);陕西省科技资源开放共享平台项目(2016FWPT-01)资助。

摘　　要：磁吻合或磁力疏通技术是一种创新性的吻合技术,可完成狭窄消化道的重建.我们采用该技术治疗常规治疗方法无效的消化道狭窄,现探讨该技术的安全性及有效性.收集2012年1月~2019年10月西安交通大学第一附属医院及中国人民解放军总医院肝胆外科收治的17例术后消化道狭窄患者:年龄11~78岁,男女比例11:6;胆道狭窄14例,结直肠吻合口狭窄1例,食管吻合口狭窄2例;完全性狭窄14例,顽固性狭窄3例;末次手术后0~120月发现狭窄,在接受2~8次无效的标准治疗后行磁力疏通技术治疗.疏通装置由子母稀土钕铁硼磁铁构成,柱状或环状.通过不同的输送路径,在狭窄消化道的上下端分别置入子母磁体,通过磁体间的磁力压迫狭窄组织而达到再通,再通后在新吻合口放置支架或进行扩张等治疗.观察指标包括术前狭窄距离、磁吻合再通时间、手术30 d内相关并发症、支架留置时间、吻合口狭窄复发等.采用门诊及电话随访,随访时间至2019年12月. 16例患者完成磁力疏通治疗(成功率94.1%),分别为10例胆道-胆道吻合、3例胆道-肠道吻合、1例食管-食管吻合、1例食管-胃吻合、1例结肠-直肠吻合. 3例患者术后早期子母磁环脱开, 2例自动复位, 1例再次经PTCD(percutaneous transhepatic cholangial drainage)窦道置入一枚子磁体复位耦合. 3例有手术并发症(急性胆管炎、胆道出血及结肠瘘各1例),均予保守治疗后好转. 16例术前狭窄段长度2~7.1(4±1.9) mm,再通时间7~50(15.5±10.6) d.再通后4例置入胆道塑料支架, 5例置入胆道全覆膜金属支架, 4例置入经皮肝胆道引流导管, 2例吻合口球囊扩张+金属支架置入, 1例单纯吻合口球囊扩张.再通后1~17(6.9±4.0)月, 14例患者拔出支架, 1例仍在支架治疗中.脱支架后随访3~70(22.5±24.9)月, 13例胆道狭窄者未见狭窄复发,其中2例出现胆道结石,内镜治愈;3例胃肠道狭窄者中有2例复发.综上�Magnetic compression anastomosis or magnetic recanalization technique is a revolutionary minimally invasive method to perform re-anastomosis in patients with alimentary strictures. We conduct magnetic recanalization for the treatment of severe alimentary strictures that cannot be treated by conventional methods. Data are analysed retrospectively in order to investigate the safety and efficiency of this method. From 2012 January to 2019 October, 17 patients with alimentary stricture after operation were enrolled in the first affiliated hospital of Xi’an Jiaotong University and the Chinese PLA General Hospital. The ages were 47±16.8 years, and 11 cases were men. 17 cases include 14 benign biliary strictures, two esophageal strictures and one colorectal anastomosis strictures. 14 cases are complete strictures, and the others are refractory one. Strictures are found 0–120 months after the last operation. All the patients have undergone 2–8 times unsuccessful standard treatments, including endoscopic retrograde cholangiopancreatography(ERCP), percutaneous transhepatic cholangial drainage(PTCD) or endoscopic balloon dilation. Magnetic recanalization technique(MRT) is proposed. The MRT device consists of two identical, nickel-plated Nd Fe B magnets(rating, N45) termed the parent magnet and the daughter magnet. Each magnet shapes like a cylinder or annular. The daughter and parent magnet are delivered to the proximal and distal end of stricture respectively via different routes. The attraction force between the two magnets leads to necrosis of the fibrotic stricture tissue and the creation of a new transmural anastomosis. Thereafter, stent deployment or balloon dilation is performed to the new anastomosis. Data about stricture length, recanalization time, side effects in 30 days, time to remove the biliary stent and stricture recurrence are collected. All the patients are followed-up to 2019 December by telephone or outpatients service. After the MRT, 1 case fails. Magnets can couple stably in 16 patients(successf

关 键 词：磁吻合 胆道狭窄 食管狭窄 胃肠吻合口狭窄 结直肠吻合口狭窄 再通 

分 类 号：R57[医药卫生—消化系统] R454.1[医药卫生—内科学]