大鼠胃旁路 (oagb) 的一次吻合
1Institut national de la santé et de la recherche médicale (Inserm) unité mixte de recherche (UMR) 1149, Unité de formation et de recherche (UFR) de Médecine Paris Diderot,Universit é Paris Diderot, Assistance Publique-Hôpitaux de Paris (AP-HP), 2Department of digestive Surgery,AP-HP Hôpital Européen Georges Pompidou, 3Department of General and Visceral Surgery,Bichat-Claude Bernard University Hospital
Summary
该方案适用于大鼠胃旁路 (oagb) 的表现。操作人员执行一个长的和管状钉胃袋, 然后是手工缝合吻合。对于这种模型, 操作人员在人类中再现了双胰腺和普通肢体之间的相同比例;因此, 胆肠胰腺肢体的尺寸为35厘米。
Abstract
该方案的目标是建立一个肥胖大鼠的临床前减肥手术模型, 更具体地说, 是 oagb。基于这一临床前模型, 可以进行纵向研究, 以提供更好地了解的机制背后的结果后看到的减肥手术后, 在人类。为此, 大鼠在全身麻醉下使用异氟醚进行剖腹手术。首先, 外科医生创建一个长的和管状的胃袋: 在更大的曲线和裂孔解剖后, 非腺胃被钉和删除。然后, 剩余的胃也被钉在一起, 以创建胃管, 并排除胃的肛门。之后, 外科医生从十二指肠空肠角进行一个端侧胃空肠造口术35厘米。选择这种肢体长度是为了复制与人类减肥手术相同的双肢肢体 (bpl) 长度和普通肢体长度之间的比率。手术结束时, 通过神经和皮肤闭合。术后早期的管理包括皮下注射水合作用、肌肉内预防性抗生素注射、异洛卡因顶叶注射、止痛药的服用和饮食的逐步重新引入。
Introduction
病态肥胖是西方世界的一个主要健康问题, 发病率不断上升 1.减肥手术仍然是治疗病态肥胖2的唯一长期有效治疗方法, 对肥胖相关的合群3有明显的好处.roux-en-y 胃旁路 (rygb) 仍然是黄金标准, 因为它是最古老的程序之一, 也是世界上执行次数最多的手术之一, 随访时间最长4。oagb 是一个较新的程序, 最早描述在2001年由 rutledge5。它被描述为 rygb6 的有效替代品, 并有一些优势。早期数据显示, 在减肥和解决与肥胖有关的合感 6、7方面, 与 rygb 具有类似的功效。此外, 避免了 rygb 空肠空肠吻合术的狭窄或渗漏风险, 内部疝的风险可能低于 rygb8。
减肥手术后体重下降的生理机制仍有争议, 在人类中可能难以研究9。动物模型是有用的, 以了解如何减肥手术可能会影响葡萄糖代谢, 神经内分泌修改, 或饱足机制。程序之间缺乏比较数据, 需要更好地了解这些手术的长期效果.不可能完全规范术前和术后的临床护理, 令人满意的随访可能很难实现: 一些研究报告说, 第一年11的损失到随访率高达30%。
胃旁路的概念是一个限制性程序的组合, 由于创建胃袋, 和适度的吸收不良, 由于排除十二指肠和近端空肠胃肠道转运。目前, 减肥手术中的肢体长度仍是争论的 1 2日、1 3.现有数据显示, 程序的差异很大, 尚未就 oagb14,15的最佳肢体长度达成共识。尽管如此, 许多作者报告说, oagb 16、17、18的标准为 200厘米 bpl 长度。小肠的平均长度约为700厘米19。
在全球20个国家开发了几个啮齿类动物模型, 在眼袋大小、肢体长度和迷走神经保存方面存在很大差异。但很少有作者报告实验 oagb 模型;为此, 研究小组与减肥外科医生合作, 开发了 oagb 模型。该模型开发背后的原理是模仿在人类中练习的胃旁路。该模型结合了胃袋的结构与排除的内部和胃的身体。为此, 外科医生使用订书装置对非腺性胃进行消融。与之前的第20号手术相比, 研究小组决定增加预防性抗生素治疗, 以降低与胃肠道吻合口相关的发病率, 就像人类手术中的常规一样21。
该模型中使用的大鼠肢体长度是为了再现人类 bpl 和 cl 的比例。初步测量显示, 大鼠小肠总长度在90至120厘米22之间.因此, 为 oagb 选择的 bpl 长度为35厘米。此外, 该模型是可行的, 无需任何血管结扎, 避免胃袋缺血。
Protocol
所有动物用途都符合欧洲共同体的准则, 并得到了地方伦理委员会 (第121号国家的动物扩展委员会) 和高等教育和研究部 (参考 #02285. 03) 的批准。 1. 动物和饮食 大 鼠 使用体重260-320 克的雄性 wistar 大鼠, 在7周大的时候开始高脂肪饮食 (hfd)。 饮食 导致饮食引起的肥胖, 至少有12个术前的 hfd 周。让老鼠免费获得水…
Representative Results
该协议是可重现的, 并模仿 oagb 在人类身上的实践。发布的数据23、24 支持该协议的安全性, 死亡率在12% 至25% 之间。研究小组中死亡率相似的不同外科医生都采用了这一方案。 尽管如此, 学习啮齿类动物手术是复杂的, 使用放大镜是强制性的。事实上, 微观吻合术的关键步骤需要大约1…
Discussion
该协议的优点是模仿 oagb 在人类中的常规做法。它在大鼠体内的安全性和重现性已在临床和代谢结果中得到证明。
该协议中的吻合带来了技术难题, 是主要的关键一步。为此, 有必要使用特定的显微外科工具, 如显微外科针架或放大镜。为了实现没有任何狭窄的密封吻合, 有必要在吻合的每一侧进行至少七到八个紧密缝合, 并避免在任何缝合中采取任何粘膜, 以便将其埋在缝合?…
Offenlegungen
The authors have nothing to disclose.
Acknowledgements
作者要感谢让·皮埃尔·马穆塞的不断帮助和支持;eglantine voitellier、jean-baptiste cavin 和 houneyda el jindi 用于设置模型和插图;安妮-夏洛特·贾里和安德烈亚贡卡尔维斯帮助他们的视频;sara j. zaat 编辑英文文本。matthieu a. siebert 和 lara ribero-parorente 是 mécherchémale 基金会 (frm) 和法国奇鲁吉协会 (afc) 的赞助者。
Materials
| High-Fat Diet, 45 % fat | Genestil, Royaucourt, France | C 1090-45 | http://www.genestil.com/ |
| Metzenbaum Scissors | World Precision instrument, Sarasota, US | 501739 | https://www.wpi-europe.com |
| Dumont Tweezers | World Precision instrument, Sarasota, US | 14098 | https://www.wpi-europe.com |
| Iris Forceps | World Precision instrument, Sarasota, US | 15915 | https://www.wpi-europe.com |
| Iris Scissors 10cm | World Precision instrument, Sarasota, US | 14218 | https://www.wpi-europe.com |
| Needle Holder | World Precision instrument, Sarasota, US | 14110 | https://www.wpi-europe.com |
| Alm Self Retaining Retractor | World Precision instrument, Sarasota, US | 14240 | https://www.wpi-europe.com |
| Baby Mixter Hemostatic Forceps, Right Angle | World Precision instrument, Sarasota, US | 501240 | https://www.wpi-europe.com |
| Non woven sterile swabs | LCH Medical Products, Paris, France | SN40-0755 | www.lch-medical.com |
| Galilean Binocular Loupe 2.5x | World Precision instrument, Sarasota, US | 504056 | https://www.wpi-europe.com |
| Digestive thread: Isotactic polypropylene, monofil Prolene 7-0 | Ethicon, Issy les Moulineaux, France | EH7813E | www.ethicon.com |
| Parietal thread : Coated Braided Polyester Ti-Cron 2-0 | Covidien, Mannsfield, MA, USA | 3003-52 | www.covidien.com |
| Cutaneous thread : Polyglactin, VICRYL RAPIDE 4-0 | Ethicon, Issy les Moulineaux, France | VR3100 | www.ethicon.com |
| ETS-Flex 35- mm staple gun | Ethicon, Issy les Moulineaux, France | ATS45 | www.ethicon.com |
| Proximate Reloadable Staplers | Ethicon, Issy les Moulineaux, France | XR30V | www.ethicon.com |
| TA-DST 30mm-3.5mm | Ethicon, Issy les Moulineaux, France | TX30B | www.ethicon.com |
| Alcoholic 5% Betadine | MEDA Pharma, Merignac, France | 41085 | www.medapharma.fr |
| LIDOCAINE AGUETTANT 20 mg/ml | LABORATOIRE AGUETTANT, Lyon, France | 3400940000000.0 | https://www.aguettant.fr |
| Penicillin G 5MUI | Panpharma, Luitre, France | 3.40E+12 | https://www.panpharma.eu/fr |
| Bionolyte G5 ; Sodium chloride 0.4%, glucose 5%, potassium chloride 0.2%) | Baxter, Maurepas, France | ||
| Liquid diet | Genestil, Royaucourt, France | C-0200T | http://www.genestil.com/ |
| Isoflurane 100% | Centravet, Plancoet, France | ISO007 | http://cooperative.centravet.net |
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Diesen Artikel zitieren
Siebert, M. A., Chevallier, J., D’Aurelle de Paladines, D., Pottier, Y., Msika, S., Le Gall, M., Bado, A., Ribeiro-Parenti, L. One-anastomosis Gastric Bypass (OAGB) in Rats. J. Vis. Exp. (141), e58776, doi:10.3791/58776 (2018).