基于磁压榨技术的无创化胃造瘘的大鼠模型研究
作者:
通讯作者:
作者单位:

1.西安交通大学第一附属医院,肝胆外科,陕西 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; 西安交通大学,陕西 西安 710061;3.西安交通大学第一附属医院,启德书院,陕西 西安 710061;4.西安交通大学第一附属医院,宗濂书院,陕西 西安 710061

作者简介:

张苗苗,西安交通大学第一附属医院硕士研究生,主要从事磁外科、肝胆胰疾病方面的研究。

基金项目:

国家自然科学基金资助项目(81700545);陕西省创新能力支撑计划资助项目(2020KJXX-022);陕西省重点研发计划资助项目(2021SF-163);陕西省西安交通大学大学生创新训练项目(S202110698414)。


Noninvasive gastrostomy based on magnetic compression technique: an experimental study in rat models
Author:
Affiliation:

1.Department of Hepatobiliary Surgery, Xi'an Jiaotong University, Xi'an 710061, China;2.National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China, Xi'an Jiaotong University, Xi'an 710061, China;3.Qide College, Xi'an Jiaotong University, Xi'an 710061, China;4.Zonglian College, Xi'an Jiaotong University, Xi'an 710061, China

Fund Project:

  • 摘要
  • |
  • 图/表
  • |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 引证文献
  • |
  • 资源附件
  • |
  • 音频文件
  • |
  • 视频文件
    摘要:

    背景与目的 胃造瘘术是普通外科常见手术,传统胃造瘘术创伤大,已逐步被内镜下胃造瘘、X线下胃造瘘术取代,但实施过程需要内镜系统或X线机辅助,且操作较为繁琐。基于应用磁压榨技术行无创化胃造瘘的设想,本研究采用自行设计加工的胃造瘘磁体装置,在大鼠模型上验证该设想的可行性和安全性。方法 根据大鼠消化道解剖特点和尺寸自行设计加工适合于大鼠胃造瘘的钕铁硼子母磁体,电子万能试验机测试子母磁体的磁力学曲线。10只SD大鼠麻醉后经口置入子磁体至胃内,在大鼠左上腹部放置母磁体,子母磁体自动吸合,腹部X线明确磁体相吸情况。术后单笼饲养,观察大鼠存活状况、磁体脱落时间、磁体留置期间并发症发生情况。术后2周处死动物,获取造瘘口标本,肉眼及光镜下观察造瘘口形成情况。结果 设计和生产出的子母磁体均为圆柱状,采用N42烧结钕铁硼加工而成,表面电镀镍防护处理。子磁体直径5 mm、高3 mm,母磁体直径6 mm、高5 mm,子母磁体质量分别为0.410 g和1.035 g。子母磁体在零距离时最大吸力达4.36 N,磁体吸力随位移增加而逐渐减小。10只大鼠麻醉后均成功经口置入子磁体至胃内,在大鼠左上腹部放置母磁体后,子母磁体迅速相吸,腹部X线检查显示磁体对位吸合良好。术后大鼠均存活,子母磁体留置期间,未出现磁体移位、子母磁体分离等意外事件,所有实验动物无消化道梗阻、腹腔感染等并发症。术后10~13 d子母磁体脱落,胃造瘘通道建立。术后2周开腹观察可见造瘘口处胃壁和腹壁粘连愈合牢固,腹腔无渗液及粘连。获取造瘘口标本肉眼可见瘘口形成良好,HE及Masson染色光镜下观察可见瘘口组织结构层次清晰。结论 基于磁压榨技术的胃造瘘磁体设计巧妙、易于加工、成本低,该方法建立无创化大鼠胃造瘘操作简单,安全可行,造瘘口各层组织愈合良好。下一步可开展与人体解剖特点更接近的大动物实验验证其可行性并评价造瘘口形成的长期效果。未来优化磁体设计和操作路径后,该技术有望在临床试用开展。

    Abstract:

    Background and Aims Gastrostomy is a common operation in general surgery. Traditional gastrostomy has been gradually replaced by endoscopic gastrostomy and X-ray gastrostomy due to the great surgical trauma. However, the implementation process requires the assistance of endoscopic system or X-ray machine, and the procedure is complicated. Based on the assumption of performing a noninvasive gastrostomy by magnetic compression technique, this study was conducted to verify the feasibility and safety of this assumption in rat models using a self-designed and developed magnet device for gastrostomy.Methods According to the anatomical characteristics and size of rat digestive tract, the parent and daughter magnets made from Ndfeb and suitable for rat gastrostomy were designed and produced. The magnitude of the magnetic force between the parent and daughter magnets was tested by electronic universal testing machine. In 10 SD rats, the daughter magnet was inserted into the stomach through mouth after anesthesia and the parent magnet was placed in the left upper abdomen. After the two magnets automatically latched onto each other, the attraction status was confirmed by abdominal X-ray. After operation, the rats were raised in a single cage, the survival status, time of magnet detachment, and complications during magnets retention were observed. The animals were sacrificed 2 weeks after the operation, and the gastrostomy specimens were obtained to observe the formation of the gastrostomy under naked eye and light microscope.Results Both the self-designed and produced parent and daughter magnets were cylindrical shaped and made from N42 sintered Ndfeb, with nickel plating on the surface. The diameter and height of the daughter magnet were 5 mm and 3 mm, and the diameter of the parent magnet were 6 mm and 5 mm, respectively. The mass of the daughter magnet and parent magnet were 0.410 g and 1.035 g respectively. The maximum adhesive force of the parent and daughter magnets was 4.36 N in direct contact, and the magnetic force of the magnets decreased with the increase of displacement. The daughter magnets were successfully inserted into the stomach of all the 10 rats after anesthesia. After the parent magnets were placed in the left upper abdomen of rats, the daughter and parent magnets were rapidly attracted to each other. Abdominal X-ray examination showed that the magnets stuck in right position. All rats survived after operation. During the period of retention of the parent and daughter magnets, there were no accidents such as magnetic displacement and separation of the magnets occurred, and no complications such as digestive tract obstruction and abdominal infection occurred in all experimental animals. The magnets were detached and the gastrostomy channel was established 10 to 13 days after operation. Two weeks after the operation, the adhesion between stomach and abdominal wall around the fistula stoma was firmly healed, and there was no exudation and adhesion in the abdominal cavity. The specimens of the fistula stoma were obtained, naked-eye observation found that the fistula stoma was well formed, and the tissue structure of the fistula was clear under HE and Masson staining and light microscope.Conclusion The magnet device for gastrostomy based on magnetic compression technique is cleverly designed, easy to process and low cost. The establishment of non-invasive gastrostomy in rats by this method is simple, safe and feasible, and the tissues of each layer of the fistula can heal well. The next step is to carry out experiments in large animals that are more similar to human anatomy to verify its feasibility and evaluate the long-term effects of the fistula formation. Clinical trials of this technique are expected in the future after optimization of the design of magnets and the operating procedure.

    图1 用于大鼠胃造瘘的子母磁体 A:子母磁体侧面图;B:子母磁体底面图;C:子母磁体吸合状态Fig.1 Parent and daughter magnets for gastrostomy in rats A: Lateral view of the parent and daughter magnets; B: Bottom view of the daughter and parent magnets; C: Bonding state of daughter and parent magnets
    图2 磁力位移曲线测试图 A:磁力位移曲线测试示意图;B:子母磁体间的磁力位移曲线Fig.2 Magnetic force displacement test curve A: Schematic diagram of magnetic force displacement test curve; B: Magnetic force displacement curve between parent and daughter magnets
    图3 X线下观察磁体对位吸合状态(箭头所指为子母磁体) A:正位片;B:侧位片Fig.3 X-ray observation of the magnet on the position of the state (the arrow indicating the parent and daughter magnets) A: Anteroposterior radiograph; B: Lateral radiograph
    图4 肉眼观察造瘘标本 A:开腹可见胃造瘘处胃壁与腹壁粘连牢固,周围无粘连;B:胃内充满水后观察造瘘通道;C:血管钳探查造瘘通道畅通性良好;D:胃侧观察所见造瘘口;E:皮肤侧观察所见造瘘口;F:沿造瘘通道纵向剖开所见造瘘通道(图中黑色箭头所指为造瘘口,白色箭头所指为造瘘通道,三角所示为腹壁,星号所示为胃)Fig.4 The gastrostomy specimen observed by naked eye A: After laparotomy, firm sticking of the gastric wall and abdominal wall at gastrostomy, without surrounding adhesions; B: Observation of the gastrostomy channel after filling the stomach with water; C: Exploration of the gastrostomy channel with vascular forceps showing smooth and patent lumen; D: View of the gastrostomy on gastric side; E: View of the gastrostomy on the skin side; F: Longitudinal incision of the gastrostomy along the fistula channel (the black arrow indicating the gastrostomy stoma, the white arrow indicating the gastrostomy channels, the triangle indicating the abdominal wall, and the asterisk indicating the stomach)
    图5 光镜下所见造瘘通道组织学结构 A:造瘘口标本HE染色(HE×20);B:造瘘口标本Masson染色(Masson×20);C:子母磁体间的压榨坏死组织HE染色(HE×30);D:子母磁体间的压榨坏死组织Masson染色(Masson×30)Fig.5 The histological structure of the fistula channel under light microscope A: HE staining of the gastrostomy fistula specimen (HE×20); B: Masson staining of gastrostomy fistula specimen (Masson×20); C: HE staining of the necrotic tissue between the parent and daughter magnets (HE×30); D: Masson staining of the necrotic tissue between the parent and daughter magnets (Masson×30)
    参考文献
    相似文献
    引证文献
引用本文

张苗苗,吉琳,盖敬慈,雷凤萍,刘培楠,王伊睿,蓝婷,张涵芷,李恒,吕毅,严小鹏.基于磁压榨技术的无创化胃造瘘的大鼠模型研究[J].中国普通外科杂志,2021,30(10):1175-1183.
DOI:10.7659/j. issn.1005-6947.2021.10.007

复制
分享
文章指标
  • 点击次数:
  • 下载次数:
历史
  • 收稿日期:2021-02-04
  • 最后修改日期:2021-09-23
  • 录用日期:
  • 在线发布日期: 2021-11-02