中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (43): 6458-6464.doi: 10.3969/j.issn.2095-4344.2016.43.011

• 材料生物相容性 material biocompatibility • 上一篇    下一篇

镍钛记忆合金加压吻合夹用于胃肠道吻合的安全有效性

郑  桁，杨  春，郭志义，王  康，张  伟，侯能易
  

  1. 四川省医学科学院•四川省人民医院胃肠外科，四川省成都市  610072
  • 收稿日期:2016-09-07 出版日期:2016-10-21 发布日期:2016-10-21
  • 通讯作者: 杨春，硕士，副主任医师，四川省医学科学院?四川省人民医院胃肠外科，四川省成都市 610072
  • 作者简介:郑桁，男，四川省人，汉族，1974年华中科技大学同济医学院毕业，硕士，主治医师，主要从事胃肠方面的研究。
  • 基金资助:

    四川省卫生厅课题(2012JY0055)

Safety and efficacy of nickel-titanium memory alloy compression anastomosis clip in gastroenterostomy

Zheng Hang, Yang Chun, Guo Zhi-yi, Wang Kang, Zhang Wei, Hou Neng-yi
  

  1. Department of Gastrointestinal Surgery, Sichuan Academy of Medical Science & Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China
  • Received:2016-09-07 Online:2016-10-21 Published:2016-10-21
  • Contact: Yang Chun, Master, Associate chief physician, Department of Gastrointestinal Surgery, Sichuan Academy of Medical Science & Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China
  • About author:Zheng Hang, Master, Attending physician, Department of Gastrointestinal Surgery, Sichuan Academy of Medical Science & Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China
  • Supported by:
    the Project of Health Department of Sichuan Province, No. 2012JY0055

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被引次数

4

摘要：

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文题释义：
镍钛记忆合金加压吻合夹：是一个直径30 mm的双环椭圆装置，其具有随环境温度变化形状的能力，使吻合夹能够压缩肠壁，引起肠壁吻合部位坏死，同时伴随肠壁组织修复愈合。镍钛记忆合金加压吻合夹可直接对肠壁产生持续稳定的压力致使组织逐渐坏死，同时又能确保断端愈合并有充足的血供支持，从而达到无缝合吻合，而黏膜上皮再生修复形成一个功能完整的吻合口。
金属钉管状吻合器：与手工缝线相比，金属钉管状吻合器吻合口的组织反应相对较轻，愈合过程则更加快速，近来被临床广泛使用，但吻合口狭窄、缺血性坏死等情况仍时有发生。管状吻合器的吻合钽钉将会在体内永远存在，除了会产生影像学伪影外，还可能造成吻合口纤维组织增生及形成瘢痕，从而会导致发生吻合口狭窄的概率升高。

背景：目前镍钛记忆合金于人造血管、骨科内固定器及矫形支架等方面广泛应用，其生物学特性已得到共识，而加压吻合方法目前已比较成熟。
目的：评价应用镍钛记忆合金加压吻合夹行胃肠吻合的有效性和安全性。
方法：纳入2013年6月至2016年2月四川省人民医院收治的64例胃空肠吻合患者，所有患者均行远端胃大部切除，按治疗方案均分为2组。加压吻合夹组及对照组分别使用加压吻合夹及一次性钽钉管状吻合器进行胃肠吻合。
结果与结论：2组在手术时间、胃空肠吻合时间、术后肠排气时间、进食时间及住院时间等方面均无显著差异(P > 0.05)。2组均未发生术中吻合口出血、术后吻合口瘘及胃排空障碍等并发症。加压吻合夹组未发生吻合口狭窄；但对照组出现1例，发生率为3%。加压吻合夹组术后3 d腹部X射线检查显示加压吻合夹均在原位，加压吻合夹于术后9-28 d排出体外，术后6个月复查胃镜，显示胃肠吻合口光滑平整，无充血水肿，组织反应轻。说明应用加压吻合夹进行胃肠吻合安全可靠，可取得与一次性钽钉管状吻合器相同甚至更优的吻合效果，且具有良好的组织相容性，吻合口组织反应轻，不会引起吻合口狭窄等吻合口相关并发症。

关键词: 生物材料, 材料相容性, 胃肠吻合, 加压吻合夹, 镍钛记忆合金, 远端胃大部切除, 组织相容性, 手工缝线吻合, 机械吻合

Abstract:

BACKGROUND: The nickel-titanium memory alloy has been extensively used in blood vessel prosthesis, internal fixation, and orthopedic stents, and its biological characters have obtained better understanding. In the meanwhile, the compression anastomosis technology has been mature.
OBJECTIVE: To evaluate the safety and efficacy of nickel-titanium memory alloy compression anastomosis clip (CAC) in gastrointestinal anastomosis.
METHODS: Totally 64 patients undergoing distal subtotal gastrectomy from June 2013 to February 2016 in Sichuan Provincial People’s Hospital were divided into two groups. Patients in CAC and control groups underwent gastrointestinal anastomosis using the CAC and disposable tantalum nail stapler, respectively.
RESULTS AND CONCLUSION: There were no significant differences in the operation time, stomach jejunum anastomosis time, postoperative exhaust time, eating time and hospitalization time between groups (P > 0.05). No complications such as anastomotic bleeding, anastomotic leakage and delayed gastric emptying occurred in the two groups. There was no anastomotic stenosis in the CAC group, but one case in the control group with the incidence of 3%. The abdominal X-ray examination of CAC group at postoperative 3 days showed that the CAC did not move, and was excreted at postoperative 9-28 days. Six months after operation, the gastrointestinal anastomosis was smooth without congestion and edema under endoscopy. In conclusion, the CAC for gastrointestinal anastomosis is safe and reliable, achieving the same or even better results with a disposable tantalum nail stapler, and will not cause anastomotic complications due to good histocompatibility.

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