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目的观察腹腔镜胃底折叠抗反流手术联合胃袖状切除术对动物模型的可行性和安全性。方法 2013年12月至2014年5月在柯惠上海临床培训中心及奥林巴斯上海实验室对8只小猪行腹腔镜下保留部分胃底的胃袖状切除术联合食管裂孔疝修补术及不同类型胃底折叠术(包括Nissen、Toupet、Dor胃底折叠术)。记录术中情况、手术步骤、技术难点及注意事项等。结果成功完成小猪腹腔镜胃袖状切除术和食管裂孔疝缝合修补术8次,不同类型胃底折叠术24次,即Nissen胃底折叠术、Toupet胃底折叠及Dor胃底前折叠术各8次。无一例中转开腹,所有实验动物均在手术中生命体征保持平稳,平均手术时间为(120.2±13.7)min,出血量为5~80(35.8±11.1)m L。术中1只发生肝损伤出血,其余均未发生脏器损伤及吻合口漏。手术时间随着训练次数明显缩短。结论腹腔镜胃底折叠抗反流手术联合胃袖状切除术对小猪动物模型安全可行,可为临床医师提供极佳训练机会,有助于缩短学习曲线,可能成为治疗肥胖合并胃食管反流病或食管裂孔疝的新型抗反流手术方法。
Objective To observe the feasibility and safety of laparoscopic fundoplication with anti-reflux surgery and gastrodotomy in animal models. Methods From December 2013 to May 2014, part of the gastric fundus resection combined with esophageal hiatal hernia repair was performed laparoscopically in 8 piglets at Kehui Shanghai Clinical Training Center and Olympus Shanghai Lab. And different types of fundoplication (including Nissen, Toupet, Dor fundoplication). Record intraoperative conditions, surgical procedures, technical difficulties and precautions. Results Laparoscopic gastrodotomy and esophageal hiatal hernia repair were successfully performed in piglets eight times. Different types of fundoplication were performed 24 times, ie Nissen fundoplication, Toupet fundoplication and Dor fundoplication 8 times. None of the patients switched to laparotomy. The vital signs of all the experimental animals remained stable during the operation. The average operation time was (120.2 ± 13.7) min and the bleeding volume was 5-80 (35.8 ± 11.1) m L. Intraoperative bleeding occurred in only one liver injury, the rest did not occur organ damage and anastomotic leakage. The operation time was significantly shortened with the number of training. Conclusions Laparoscopic fundoplication and gastrocytic resection combined with gastrocyte resection are safe and feasible for piglet animal models and provide excellent training opportunities for clinicians and help to shorten the learning curve and may become the treatment of obesity combined with gastroesophageal reflux A new antireflux surgical approach to disease or esophageal hiatal hernia.