动物实验探讨内镜经胃入路保胆手术的安全性  

To explore the safety of transgastric endoscopic gallbladder-preserving surgery through animal experiments

作　　者：莫业珍 郭先文[1] 黄鹏宇[1] 何志钧[1] 黄宗声 曾义庆 张琳琦 梁美山[1] 梁运啸[1] MO Ye-zhen;GUO Xian-wen;HUANG Peng-yu;HE Zhi-jun;HUANG Zong-sheng;ZENG Yi-qing;ZHANG Lin-qi;LIANG Mei-shan;LIANG Yun-xiao(Department of Gastroenterology,People’s Hospital of Guangxi Zhuang Autonomous Region,530021 PRC)

机构地区：[1]广西壮族自治区人民医院消化内科,530021

出　　处：《现代消化及介入诊疗》2022年第2期149-154,共6页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S2017085)。

摘　　要：目的通过动物活体实验探索内镜经胃入路保胆手术的安全性。方法选择小型猪5只,静脉麻醉后,在胃镜下,用电刀切开胃壁,将内镜送入腹腔。找到胆囊并切开,内镜进入胆囊腔内进行探查和冲洗。金属夹闭合胆囊切口和胃壁切口。术后动物饲养1个月,剖腹探查。观察技术成功率、操作时间、血常规及肝功能的变化和并发症发生情况。结果5只猪均完成内镜经胃入路保胆手术,技术成功率100%,平均手术时间(143.6±9.3)min。术中80%动物肝脏表面被电灼伤,60%动物再次定位胆囊切口困难,60%动物出现耳面血氧指数下降。术后所有动物生存良好。术后1月与术后24 h比较,血中性粒细胞数、血小板、白蛋白差异有统计学意义(P<0.05);余血常规、肝功能、血淀粉酶、血脂等指标,在两两比较中差异无明显统计学意义(P>0.05)。复查及解剖见胃和胆囊切口愈合良好,无出血、穿孔、胆瘘等并发症发生。但手术胃镜未灭菌的动物术后出现感染及胆囊切口旁脓肿。结论内镜经胃入路保胆手术安全可行,操作技术可进一步改良。Objective To explore the safety of transgastric endoscopic gallbladder-preserving surgery approach was through live animal experiments.Methods Five miniature pigs were selected.After intravenous anesthesia,the gastric wall was cut open by electric knife under gastric endoscope and the endoscope was sent to abdominal cavity.Find the gallber and cut open,and endoscopy was entered into the gallbladder cavity for laddexploration and washing.Then the gallbladder incision and the gastric wall incision were closed with titanium clips.Then the gallbladder incision and the gastric wall incision were closed with titanium clips.the five pigs were housed for one month and examined by laparotomy after surgery.Then observe the technical success rate,operation time,blood routine and liver function changes and complications were observed.Results All five pigs were completed endoscopic gastric approach and biliary-preserving surgery,with a technical success rate of 100%,and the average surgical time was(143.6±9.3)min.During the operation,the liver surface of 80%of animals was electroburned,60%was difficult to relocate the gallbladder incision,and 60%showed an oxygen decrease in auricular blood oxygen index.All the animals survived well after surgery.There were statistically significant differences in neutrophil count,platelet count and albumin between 1 month after surgery and 24 hours after surgery(P<0.05);There were no significant differences in residual blood routine,liver function,blood amylase and blood lipids(P>0.05).Reexamination and anatomy showed that the incision of stomach and gallbladder healed well,with no complications of bleeding,perforation,bile fistula and so on.However,postoperative infection and abscess near gallbladder incision occurred in the animals with unsterilized gastroscope.Conclusion Transgastric endoscopic surgery for gallbladder preservation is safe and feasible,and the operative technique can be further improved.

关 键 词：自然腔道内镜手术 胆囊探查术 动物实验 安全性 并发症 

分 类 号：R-332[医药卫生] R573