【作者】 贺庆；

【导师】 熊力；

【作者基本信息】 中南大学 ， 临床医学（专业学位）， 2022， 硕士

【摘要】 目的:消化道瘘是普外科常见的并发症之一,其危害重,而部分消化道瘘尚缺乏相应的疾病动物模型对其进行研究。本研究尝试运用改良磁压榨技术构建直肠阴道瘘动物模型、食管胸膜瘘动物模型,并将“磁”与3D打印技术结合,设计并制造一款容易组装且易于排出的椭圆形肠道磁力吻合环,研究使用锯齿状凸出边缘的外壳进行空肠吻合的效果。方法:(1)选择新西兰大白兔进行建模。将磁体分别置于5只实验雌兔阴道后壁和直肠前壁,可对压榨部位产生约6.05N的力,压强约157.27KPa,构建直肠阴道瘘动物模型。术后观察实验兔生存情况、磁体脱落时间,使用我们团队自主研发的小鼠肠镜了解瘘口状态并于术后第15天取瘘口组织行病理检查;(2)将磁体分别植入5只实验兔的食道下段和右胸腔,可对压榨部位产生约3.30N的力,压强约262.92KPa,构建食管胸膜瘘动物模型。术后观察兔生存情况、磁体排出时间,术后第20天取瘘口组织行病理检查;(3)自制的磁环在兔空肠内对合可产生约1.49N的力,压榨部位压强约为89.10k Pa。对10只实验兔空肠进行空肠侧-侧吻合,术后观察兔生存状态、磁吻合环排出时间,术后第20天取吻合口标本进行测量及病理检查。结果:直肠阴道瘘模型构建成功:术后第7天使用小鼠活体内镜(肠镜)可见新鲜瘘口,瘘口在术后5.8±0.8(n=5)天形成。食管胸膜瘘模型构建成功:磁体在术后7.0±0.8(n=4)天排出,均形成胸腔脓肿,1例磁体残留于胸腔脓肿内;10例空肠侧-侧吻合实验兔中8例空肠吻合口顺利形成,磁力压榨吻合装置于术后10.3±2.0天(n=8)排出;2例因手术并发症死亡。结论:本研究运用磁压榨技术成功构建直肠阴道瘘和食管胸膜瘘疾病动物模型。自制的组装式肠道磁力吻合环在兔消化道内具有良好的通过性且可形成较大的肠吻合口。兔肠道吻合中运用磁环外壳凸出边缘进行压榨的方式具有一定可行性。图24幅,表4个,参考文献59篇更多还原

【Abstract】 Purpose:Gastrointestinal fistula is one of the common complications seen in general surgery.While causing great harm,some gastrointestinal fistulas still lack corresponding animal disease models to study them.This study attempts to use improved magnetic compression technology to construct rectovaginal fistula animal model,esophagopleural fistula animal model,and combine"magnetism"with 3D printing technology to design and manufacture an oval-shaped intestinal magnetic anastomosis ring that is easy to assemble and easy to discharge,and test the effect of jejunal anastomosis using the jagged outer shell with protruding edges of the ring.Methods:（1）New Zealand white rabbits were chosen as test subjects.A magnet was separately placed on the posterior vaginal wall and the anterior rectum wall of 5 experimental female rabbits,generating a force approximately of 6.05N and pressure approximately of 157.27KPa to form the rectovaginal fistula animal model.Post-operation,the survival of rabbits,time of magnet discharge were observed.Fistulas were viewed with the mice colonoscope independently developed by our team.Fistula tissue was taken for pathological examination on the 15^th day after surgery.（2）A magnet was implanted into the lower esophagus and right thoracic cavity of 5 experimental rabbits respectively,generating a force approximately of 3.30N and pressure approximately of 262.92KPa to form the esophagopleural animal model.Post-operation,the survival of rabbits,time of magnet discharge were observed.Pathological samples of fistulas were harvested on the 20^th day after surgery.（3）The self-made magnetic ring can produce a force of approximately 1.50N in the jejunum of rabbits,and the pressure at the pressure site is 89.10k Pa。10 side-to-side anastomosis of jejunum was performed using the self-made magnetic ring.Post-operation,the survival of rabbits,the discharge time of the magnetic device were observed.Pathological samples of fistulas were harvested on the 20^th day after surgery.Results:Rectovaginal fistula animal model was successfully established.On the 7^th day after surgery fresh fistulas can be observed with our mice in vivo colonoscope,and the fistula was formed 5.8±0.8（n=5）days after surgery.Esophago-pleural fistula animal model was successfully established.The magnets were discharged 7.0±0.8（n=4）days after the operation,and all rabbits formed a thoracic abscess with one had its magnet incarcerated in the abscess.The magnetic device was discharged10.3±2.0 days after the operation（n=8）.2 rabbits died due to surgical complications.Conclusion:In this study,we successfully constructed animal models of rectovaginal fistula and esophagopleural fistula using magnetic compression technology.The self-made assembled magnetic intestinal anastomosis ring has good passability in the rabbit’s digestive tract and can form a larger intestinal anastomosis.It may be feasible to use the protruding edge of the magnetic ring’s shell for intestinal anastomosis in rabbits.更多还原