CAJ | 학술논문

目的探讨内镜下金属夹腔内夹闭行肠穿孔修补术的安全行和可行性.方法对4头巴马小型猪进行长约2 cm的肠全层穿孔造模.1头未行修补术,作对照;其余3头采用三爪和二爪金属夹各2枚闭合,其中1头在金属夹闭合创口后表面注射纤维蛋白胶.4头均在术后第14天处死,行大体标本观察、亚甲蓝渗漏试验、腹腔液细菌培养和病理学检查.术后2周内观测和记录4头猪的体温、白细胞等一般情况变化,并行分类比较.结果 4头猪均成功完成了肠穿孔造模术.3头猪内镜下肠穿孔修补术均获成功,术后2周内体温、血白细胞计数均较对照猪明显降低或减少(P<0.05),一般情况更好.解剖后大体标本显示,对照猪肠创口未完全闭合,周围有多处粘连,病理示全层缺损;2头行金属夹闭合术的猪,肠创口完全闭合,病理示基本修复,腹腔内未见明显粘连现象;1头行金属夹联合注射纤维蛋白胶的猪,肠创口周围有多处粘连,病理示不完全修复.结论内镜下对直径2 cm大小的肠穿孔行金属夹闭合的方法安全可行,可有效修复创口,但联合使用纤维蛋白胶对闭合创口是否具有优势尚需进一步的实验证实.
목적 탐토내경하금속협강내협폐행장천공수보술적안전행화가행성.방법 대4두파마소형저진행장약2 cm적장전층천공조모.1두미행수보술,작대조;기여3두채용삼조화이조금속협각2매폐합,기중1두재금속협폐합창구후표면주사섬유단백효.4두균재술후제14천처사,행대체표본관찰、아갑람삼루시험、복강액세균배양화병이학검사.술후2주내관측화기록4두저적체온、백세포등일반정황변화,병행분류비교.결과 4두저균성공완성료장천공조모술.3두저내경하장천공수보술균획성공,술후2주내체온、혈백세포계수균교대조저명현강저혹감소(P<0.05),일반정황경호.해부후대체표본현시,대조저장창구미완전폐합,주위유다처점련,병리시전층결손;2두행금속협폐합술적저,장창구완전폐합,병리시기본수복,복강내미견명현점련현상;1두행금속협연합주사섬유단백효적저,장창구주위유다처점련,병리시불완전수복.결론 내경하대직경2 cm대소적장천공행금속협폐합적방법안전가행,가유효수복창구,단연합사용섬유단백효대폐합창구시부구유우세상수진일보적실험증실.
Objective To evaluate the feasibility and safety of endoscopic intraluminal closure of small colon perforation with metal clips in porcine model.Methods A 2 cm full-thickness colon perforation was made in 4 bama mini-pigs.One did not receive local closure as a control, while 3 others underwent closure with bi-and tri-arm clips, one of which received additional fibrin glue injection after closure.Necropsy was done on day 14 after the procedure, and dye leak test, peritoneal fluid bacteria culture and histological examination were performed.During the 2 week observation period, the body temperature and blood leukocytes count were recorded and compared.Results Endoscopic closure of the colon perforation was technically successful in all 3 pigs.The body temperature and blood leukocyte count of these pigs were both lower than those of the control.Necropsy showed that the perforation in control pig was not completely closed and with multiple adhesions around.Perforation complete closure and pathological healing without adhesion were observed in 2 pigs with clip closure only, while adhesion and incomplete pathological healing was detected in the other one with clip closure plus fibrinogen injection (P＜0.05).Conclusion Endoscopic intraluminal closure of a 2 cm colon perforation with metal clips is feasible and safe, while further study is needed to evaluate the effect of combined local fibrinogen injection.