新型原位人工直肠括约肌系统体内效果初步探讨
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摘要
目的初步探讨新型原位人工直肠括约肌系统生物相容性和大便管控效果。方法通过相关血液指标、大体标本及组织学观察、泛影葡胺肠道造影等方法观察该新型原位人工直肠括约肌系统在动物(猪)体内生物相容性和大便管控效果。结果生物相容性:白细胞和C-反应蛋白在术后1月左右已基本恢复至术前水平,手术前后变化不明显,其差异无统计学意义(P>0.05);肝肾功能检测未发现手术前后各指标间有明显变化,差异无统计学意义(P>0.05)。大体标本和组织学检查:大体标本可见人工直肠和猪自身直肠吻合处相接严密,无明显充血红肿、感染及溃破等表现。组织学观察透明状聚酯网片已被肉芽组织严密包裹,周边有巨噬细胞和慢性炎性细胞(主要是淋巴细胞)浸润。复方泛影葡胺造影显示,造影剂可以被新型人工直肠括约肌完全管控,开阖自如、反应灵敏。结论该新型原位人工直肠括约肌系统生物相容性良好,大便管控效果确实、开阖自如,为大便失禁的治疗提供了一种新的治疗思路,非常值得进一步研究。
Objective To explore the biocompatibility and stool control effect of the novel in situ artificial bowel sphincter.Methods The biocompatibility and stool control effect of the novel in situ artificial bowel sphincter system in animals(pigs)were observed by means of related blood index,large specimen and histological observation,and diatrizoate intestinal angiography.Results At the time 1 month after operation white blood cells and C-reactive protein had almost recovered to the preoperative level,and there was no significant difference before and after operation.The difference was not statistically significant(P>0.05).There were no significant changes in the indexes of liver and kidney function before and after operation(P>0.05).The large specimens showed that the anastomosis of the artificial rectum and the pig's own rectum were tight,and there was no obvious hyperemia,redness,infection and rupture.Histological observation showed that the transparent polyester mesh had been tightly wrapped by granulation tissue,surrounded by macrophages and chronic inflammatory cells(mainly lymphocytes)infiltration.Diatrizoate angiography showed that contrast agents could be completely controlled by the novel artificial bowel sphincter,and the reaction was very fast.Conclusion The novel in situ artificial bowel sphincter system has good biocompatibility,stool control is effective and it's open and closed freely.It can provide a new idea for the treatment of fecal incontinence and is worth having a further study.
Objective To explore the biocompatibility and stool control effect of the novel in situ artificial bowel sphincter.Methods The biocompatibility and stool control effect of the novel in situ artificial bowel sphincter system in animals(pigs)were observed by means of related blood index,large specimen and histological observation,and diatrizoate intestinal angiography.Results At the time 1 month after operation white blood cells and C-reactive protein had almost recovered to the preoperative level,and there was no significant difference before and after operation.The difference was not statistically significant(P>0.05).There were no significant changes in the indexes of liver and kidney function before and after operation(P>0.05).The large specimens showed that the anastomosis of the artificial rectum and the pig's own rectum were tight,and there was no obvious hyperemia,redness,infection and rupture.Histological observation showed that the transparent polyester mesh had been tightly wrapped by granulation tissue,surrounded by macrophages and chronic inflammatory cells(mainly lymphocytes)infiltration.Diatrizoate angiography showed that contrast agents could be completely controlled by the novel artificial bowel sphincter,and the reaction was very fast.Conclusion The novel in situ artificial bowel sphincter system has good biocompatibility,stool control is effective and it's open and closed freely.It can provide a new idea for the treatment of fecal incontinence and is worth having a further study.
引文
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[6]Mantoo S,Meurette G,Podevin J,et al.The magnetic anal sphincter:a new device in the management of severe fecal incontinence[J].Expert Rev Med Devices,2012,9(5):483-490.
[7]Wong M T,Meurette G,Wyart V,et al.Does the magnetic anal sphincter device compare favourably with sacral nerve stimulation in the management of faecal incontinence?[J].Colorectal Dis,2012,14(6):323-329.
[8]Wang X,DaSilva G,Maron D J,et al.Outcomes of Reimplantation of the Artificial Bowel Sphincter[J].Dis Colon Rectum,2016,59(2):122-126.
[9]Keller J E,Newcomb W L,Hope W W,et al.Bursting strength evaluation in an experimental model of incisional hernia[J].Am Surg,2008,74(1):95-96.
[10]Luo Y,Higa M,Amae S,et al.Preclinical development of SMA artificial anal sphincters[J].Minim Invasive Ther Allied Technol,2006,15(4):241-245.
[2]林宏城,苏丹,康亮,等.人工肛门括约肌的研究进展[J].结直肠肛门外科,2009,15(4):290-292.
[3]Gallas S,Leroi A M,Bridoux V,et al.Constipation in 44patients implanted with an artificial bowel sphincter[J].Int J Colorectal Dis,2009,24(8):969-974.
[4]Hassan M Z,Rathnayaka M M,Deen K I.Modified dynamic gracilis neosphincter for fecal incontinence:an analysis of functional outcome at a single institution[J].World J Surg,2010,34(7):1641-1647.
[5]Borda L,Kcam E,Alvarado-Ortiz Blanco E.Alvarado-Ortiz Blanco E.Treatment of severe fecal inconti-nence withartificial sphincter[J].Rev Gastroenterol Peru,2015,35(3):258-261.
[6]Mantoo S,Meurette G,Podevin J,et al.The magnetic anal sphincter:a new device in the management of severe fecal incontinence[J].Expert Rev Med Devices,2012,9(5):483-490.
[7]Wong M T,Meurette G,Wyart V,et al.Does the magnetic anal sphincter device compare favourably with sacral nerve stimulation in the management of faecal incontinence?[J].Colorectal Dis,2012,14(6):323-329.
[8]Wang X,DaSilva G,Maron D J,et al.Outcomes of Reimplantation of the Artificial Bowel Sphincter[J].Dis Colon Rectum,2016,59(2):122-126.
[9]Keller J E,Newcomb W L,Hope W W,et al.Bursting strength evaluation in an experimental model of incisional hernia[J].Am Surg,2008,74(1):95-96.
[10]Luo Y,Higa M,Amae S,et al.Preclinical development of SMA artificial anal sphincters[J].Minim Invasive Ther Allied Technol,2006,15(4):241-245.