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使用内镜下缝合装置对闭合缺损胃壁患者行内镜下全层活检:存活猪的研究

发布日期:2014-1-29 12:40:57 文章来源:GIE 作者次数:1667
    使用内镜下缝合装置对闭合缺损胃壁患者行内镜下全层活检存活猪的研究

    背景

    本质上仍无法解释几种常见胃肠运动疾病和功能性胃肠病的发病机理。胃壁活检包括评估肠神经系统、肠间质细胞和免疫细胞的固有肌层,它可以为我们理解这些疾病的病因提供重要的见解。

    目的

    通过使用内镜粘膜粘膜安全瓣切开(SEMF)技术对全层胃活检(FTGB)的技术可行性、重现性和安全性进行确定;也对使用内镜缝合装置进行组织闭合的技术可行性、重现性和安全性进行确定,以及对离体标本肠肌层神经节的能力和长期安全性进行识别。

    设计

    单中心、临床前存活研究。

    环境

    动物研究实验室,发展型内镜单位。

    受试者

    十二头国内猪。

    干预

    接受SEMF胃固有肌层切除手术的动物。结果使用内镜下缝合装置闭合粘膜入口。动物存活2周。

    主要测量指标

    该手术的技术可行性、再现性和安全性;动物的临床病程;切除标本的组织学和免疫化学评估,以确定样本中是否有肠肌神经节。

    结果

    使用SEMF技术对12只动物中进行FTGB。通过缝合装置成功闭合了所有的动物粘膜开口。切除组织标本的平均大小为11mm。平均总手术时间为61分钟,每只动物2-4处间断缝合。对固有肌层和浆膜进行组织学检查,确认了所有动物的全层切除术。12只动物中有11只可见肌间神经节点。手术过程是顺利的。第2周,重复内镜检测和尸体解剖发现在粘膜开口位置和远端叠加神经节点切除位置无溃疡。12只动物中有10只保留完整缝合线,5只最低单波段粘连,10只保留缝合手术线。

    局限性

    动物实验。

    结论

    使用SEMF技术和内镜下缝合装置行FTGB,是技术可行的,可重复且安全。大组织标本将允许改善对多个细胞类型的分析。

    缩写词:FTGB:全层胃活检,ICC:肠间质细胞,PGP9.5 9.5蛋白基因产物,SEMF:粘膜下粘膜瓣内镜,SFC:膜下液垫粘

     


     

    Endoscopic full-thickness biopsy of the gastric wall with defect closure by using an endoscopic suturing device: survival porcine study

    Background

    The pathogenesis of several common gastric motility diseases and functional GI disorders remains essentially unexplained. Gastric wall biopsies that include the muscularis propria to evaluate the enteric nervous system, interstitial cells of Cajal, and immune cells can provide important insights for our understanding of the etiology of these disorders.

    Objectives

    To determine the technical feasibility, reproducibility, and safety of performing a full-thickness gastric biopsy (FTGB) by using a submucosal endoscopy with mucosal flap (SEMF) technique; the technical feasibility, reproducibility, and safety of tissue closure by using an endoscopic suturing device; the ability to identify myenteric ganglia in resected specimens; and the long-term safety.

     

    Design

    Single center, preclinical survival study.

    SettingAnimal research laboratory, developmental endoscopy unit.

    Subjects

    Twelve domestic pigs.

    Interventions

    Animals underwent an SEMF procedure with gastric muscularis propria resection. The resultant offset mucosal entry site was closed by using an endoscopic suturing device. Animals were kept alive for 2 weeks.

    Main Outcome MeasurementsThe technical feasibility, reproducibility, and safety of the procedure; the clinical course of the animals; the histological and immunochemical evaluation of the resected specimen to determine whether myenteric ganglia were present in the sample.

    Results

    FTGB was performed by using the SEMF technique in all 12 animals. The offset mucosal entry site was successfully closed by using the suturing device in all animals. The mean resected tissue specimen size was 11 mm. Mean total procedure time was 61 minutes with 2 to 4 interrupted sutures placed per animal. Histology showed muscularis propria and serosa, confirming full-thickness resections in all animals. Myenteric ganglia were visualized in 11 of 12 animals. The clinical course was uneventful. Repeat endoscopy and necropsy at 2 weeks showed absence of ulceration at both the mucosal entry sites and overlying the more distal muscularis propria resection sites. There was complete healing of the serosa in all animals with minimal single-band adhesions in 5 of 12 animals. Retained sutures were present in 10 of 12 animals.

    Limitations

    Animal experiment.

    ConclusionsFTGB by using the SEMF technique and an endoscopic suturing device is technically feasible, reproducible, and safe. Larger tissue specimens will allow improved analysis of multiple cell types.

    Abbreviations:  FTGB, full-thickness gastric biopsy, ICC, interstitial cells of Cajal, PGP9.5, protein gene product 9.5, SEMF, submucosal endoscopy with mucosal flap, SFC, submucosal fluid cushion

     

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