新型缝合器械胃镜下修补胃壁全层缺损的实验研究

An experimental study of a novel suture instrument for endoscopic closure of full thickness defects of the gastric wall

摘要:

目的 探讨新型缝合器械在胃镜下修补胃壁全层缺损的可行性、安全性和有效性。方法 以猪为实验动物，共10头，每头动物胃部造1个长径30 mm的穿孔模型。使用新型缝合器械胃镜下缝合穿孔，记录每处穿孔修补完成的时间及效果。10头猪均于术后14 d处安乐死，先行胃镜观察创面愈合情况，再剖腹探查腹腔感染和穿孔愈合情况，腹水采样作细菌培养，最后切取胃标本行病理学检查。结果 10头猪胃壁全层缺损模型均成功建立，胃穿孔在胃镜下均成功修补，手术时间（34.10±10.32） min，动物均存活。胃镜及剖腹观察，10例穿孔愈合良好，胃壁创口浆膜面瘢痕愈合，局部少许粘连；1例腹腔感染。腹水培养：9例阴性，1例细菌感染为化脓隐秘杆菌和大肠杆菌。病理示全组胃壁缺损处肌层修复良好。结论 新型缝合器械在普通单钳道胃镜下修补胃壁全层缺损安全、有效，为进一步临床研究提供了实验基础。

Abstract:

Objective To explore the feasibility, safety, and effectiveness of a novel suture instrument for closure of full thickness defects of the gastric wall under gastroscopy. Methods Ten pigs were used as experimental animals. Perforation model (30 mm in long diameter) was created in the stomach of each pig. The perforations were then closed by the novel suture instrument under gastroscopy. The completion time and efficacy of each perforation repair were recorded. The pigs were euthanized 14 days after the procedure. The healing condition was observed under gastroscopy. A postmortem examination was performed to observe the abdominal infection and healing condition of perforation. Ascites sample was taken for bacterial culture.The stomach biopsy were taken for histopathologic examination. Results All gastric perforation models in the 10 pigs were established successfully. Endoscopic closure for the stomach perforation was technically successful in all 10 pigs. The procedure time was 34.10±10.32 minutes. All animals survived. Gastroscopy and necropsy showed that the perforation healed well with local adhesion. One pig developed abdominal infection. Ascites culture were negative in 9 cases, 1 bacterial infection was caused by Arcanobacterium pyogenes and Escherichia coli. The pathology results showed that the muscular layer of the gastric wall defect in the entire group was well repaired. Conclusion The novel suture instrument is safe and effective in repairing full-thickness gastric wall defects under ordinary single clamp gastroscopy, providing an experimental basis for further clinical research.