经胃腔内内镜下胃空肠吻合术：从基础到动物研究的技术发展（附视频）。

Transgastric endoluminal gastrojejunostomy: technical development from bench to animal study (with video).

机构信息

Department of Surgery, Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin NT, People's Republic of China.

出版信息

Gastrointest Endosc. 2010 Feb;71(2):390-3. doi: 10.1016/j.gie.2009.09.019. Epub 2009 Dec 11.

DOI:10.1016/j.gie.2009.09.019

PMID:20004893

Abstract

BACKGROUND

Gastrojejunal anastomosis is commonly performed for palliative management of malignant gastric outlet obstruction and bariatric surgery. Natural orifice transluminal endoscopic surgery revolutionized the surgical approach to intra-abdominal surgery. This study explored the possibility of performing gastrojejunostomy (GJ) by using a hybrid natural orifice transluminal endoscopic surgery approach.

OBJECTIVE

To develop a surgical technique for the performance of transgastric endoscopic GJ (TGEJ) in a porcine model.

DESIGN

Prospective series of animal experiments.

SETTING

University hospital animal laboratory.

ANIMALS

Thirteen female domestic pigs.

INTERVENTIONS

With the animals under general anesthesia, the endoscope is passed through the gastrotomy and a segment of small bowel is retrieved into the stomach. An enterotomy is then created, and an EndoGIA stapler is introduced through an intragastric port and passed between the small bowel and stomach wall. A GJ is formed after firing of the EndoGIA stapler. The pigs are allowed to resume their diet 1 day after the operation and are allowed to survive for 2 weeks before they are euthanized. The patency of the GJ is confirmed with a repeat endoscopy, contrast study, and postmortem examination.

RESULTS

A total of 13 TEGJs were performed, 11 of which were successful. The mean operative time was 53.6 +/- 45.7 minutes. The mean time for gastrotomy was 4.7 minutes, and that for GJ was 42.5 minutes. One TEGJ was converted to open surgery because of malpositioning of the intragastric port, and the other failed because the enterotomy was too extensive. Ten of 11 pigs survived for 2 weeks, and endoscopic examination with contrast study confirmed that all the gastrojejunostomies were patent. On postmortem examination, the average size of the GJ was 30 mm.

LIMITATIONS

The length between duodenojejunal flexure and the site chosen to perform the GJ could not be determined.

CONCLUSIONS

TEGJ is technically feasible with a patent and sizable anastomosis.

摘要

背景

胃肠吻合术常用于姑息性治疗恶性胃出口梗阻和减肥手术。经自然腔道内镜外科手术彻底改变了腹腔内手术的治疗方法。本研究探索了通过混合经自然腔道内镜外科手术途径进行胃空肠吻合术（GJ）的可能性。

目的

开发一种在猪模型中进行经胃内镜 GJ（TGEJ）的手术技术。

设计

动物实验的前瞻性系列。

设置

大学医院动物实验室。

动物

13 头雌性家猪。

干预

在动物全身麻醉下，将内镜通过胃造口术，并将一小段小肠取回胃中。然后进行肠切开术，并通过胃内端口引入 EndoGIA 吻合器，并在小肠和胃壁之间传递。EndoGIA 吻合器发射后形成 GJ。手术后 1 天，猪允许恢复饮食，并允许存活 2 周，然后安乐死。通过重复内镜检查、对比研究和尸体检查确认 GJ 的通畅性。

结果

共进行了 13 例 TEGJ，其中 11 例成功。平均手术时间为 53.6 +/- 45.7 分钟。胃造口术的平均时间为 4.7 分钟，GJ 的时间为 42.5 分钟。由于胃内端口定位不当，1 例 TEGJ 转为开放手术，另 1 例因肠切开术过大而失败。11 例猪中有 10 例存活 2 周，内镜检查加对比研究证实所有胃空肠吻合术均通畅。尸检时，GJ 的平均直径为 30 毫米。