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中华胸部外科电子杂志

中华胸部外科电子杂志 ›› 2018, Vol. 05 ›› Issue (01) : 42 -46. doi: 10.3877/cma.j.issn.2095-8773.2018.01.09

所属专题： 文献；

论著

磁力环治疗胃食管反流性疾病的实验研究
孙益峰1, 杨煜1, 张晓彬1, 杨洋1, 叶波1, 郭旭峰1, 华荣1, 茅腾1, 李志刚1,†()   
  1. 1. 200030　上海交通大学附属胸科医院胸外科　上海交通大学食管疾病诊治中心
  • 收稿日期:2017-06-20 出版日期:2018-02-28
  • 通信作者: 李志刚

Experimental study on treatment of gastroesophageal reflux disease with magnetic sphincter augmentation

Yifeng Sun1, Yu Yang1, Xiaobin Zhang1, Yang Yang1, Bo Ye1, Xufeng Guo1, Rong Hua1, Teng Mao1, Zhigang Li1,†()   

  1. 1. Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
  • Received:2017-06-20 Published:2018-02-28
  • Corresponding author: Zhigang Li
  • About author:
    Corresponding author: Li Zhigang, Email:
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引用本文：

孙益峰, 杨煜, 张晓彬, 杨洋, 叶波, 郭旭峰, 华荣, 茅腾, 李志刚. 磁力环治疗胃食管反流性疾病的实验研究[J]. 中华胸部外科电子杂志, 2018, 05(01): 42-46.

Yifeng Sun, Yu Yang, Xiaobin Zhang, Yang Yang, Bo Ye, Xufeng Guo, Rong Hua, Teng Mao, Zhigang Li. Experimental study on treatment of gastroesophageal reflux disease with magnetic sphincter augmentation[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2018, 05(01): 42-46.

目的

胃食管反流性疾病(GERD)是指胃内容物反流入食管，磁括约肌增强器能够增加食管下括约肌(LES)张力达到抗反流的效果，该研究应用宁波胜杰康生物科技有限公司生产的磁括约肌增强器，验证该手术的安全性和有效性。

方法

12例实验动物(猪)通过开腹或腹腔镜的方式放置磁力环于LES处，观察饲养1、3、6个月后实验动物的饮食行为、体重和手术前后LES压力的变化；通过钡剂造影观察进食通畅度、磁力环的扩张、闭合情况。解剖实验动物后，观察植入器械是否出现移位和腐蚀，是否有食管梗阻，以及是否出现植入区域食管组织炎症、糜烂和缺血坏死等。

结果

实验动物均能正常进食，3例偶有呕吐，3例进食较快有呕吐，三组实验动物体重均增加；吞钡显示钡剂通过顺畅，无明显近端食管扩张等阻碍吞咽的相关影像表现。LES测压提示术后压力较术前明显增加；大体标本显示磁力环固定于食管下段外膜附近，贴近肌层，形成纤维组织囊；10例标本磁珠附近组织镜下未见炎症细胞浸润，2例标本见少量—中等量中性粒细胞及少量淋巴细胞浸润。

结论

磁力环装置可通过开腹或腔镜方便植入，研究表明该装置以及安装技术安全、可靠，可转化到GERD患者中。

关键词: 胃食管反流性疾病, 食管下括约肌, 磁力环
Objective

Gastroesophageal reflux disease is caused by gastric contents which reflux into the esophagus. Magnetic sphincter augmentation(MSA) can increase the tension of the lower esophageal sphincter (LES) to achieve anti-reflux effect. The study uses the MSA produced by Ningbo Senscure Biotechnology Co., Ltd., and verify the safety and effectiveness of this operation.

Methods

MSA device was implanted into the lower esophageal sphincter of 12 experimental animals (pigs) under surgical or laparoscopy. The changes of dietary behavior and body weight were observed for 1 month, 3 months and 6 months respectively.Changes of LES pressure and barium radiography which was used to observe feeding patency, expansion and closure of MSA were also measured and performed. The experimental animals were dissected, and observed whether there were displacement or corrosion of MSA, esophageal obstruction, esophageal inflammation, erosion and necrosis of the animals.

Results

The experimental animals were able to eat normally, 3 cases of occasional vomiting, 3 cases of vomiting when eating fast, 3 cases with increased body weight. Barium radiography showed no significant proximal esophageal dilation and other factors that hinder swallowing.The average LES pressure after operation had a significant increase (P<005). The mucosa of the esophagus appeared normal in all cases, and there was no device migration. There was no significant tissue inflammation for 10 cases, and 2 cases were observed to have inflammatory cell infiltration under microscope.

Conclusions

MSA can be easily implanted via laparotomy or laparoscopy. This study shows that the device and the mounting technique are safe and reliable, which can be applied to patients with gastroesophageal reflux disease.

Key words: Gastroesophageal reflux disease, Lower esophageal sphincter, Magnetic sphincter augmentation
图1 抗胃食管反流植入器械
图2 食管测量工具
图3 三组实验动物手术前后体重变化比较
图4 实验动物吞食造影剂的连摄片过程。A～D为摄片依次顺序。
图5 磁力环植入6个月后大体解剖及镜下表现。A、B.磁力环周围的纤维组织囊；C.磁力环植入后保持正常的磁珠；D、E、F.镜下磁珠附近的组织HE染色×20；D.正常组织；E.少量纤维组织反应性增生；F.纤维组织反应性增生并血管扩张、充血及出血，增生纤维组织中见少量-中等量中性粒细胞及少量淋巴细胞浸润。
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