巴马小型猪模型在内镜逆行胰胆管造影术培训中的应用价值

Application value of Bama miniature pig model in endoscopic retrograde cholangiopancrea⁃tography training

  • 摘要:
    探讨巴马小型猪模型在内镜逆行胰胆管造影术(ERCP)培训中的应用价值。
    采用实验研究方法。选取6只巴马小型猪建立动物模型开展ERCP操作,实验器材选用EP‑6000图像处理系统和ED‑580T治疗型十二指肠镜,由2名经验丰富的主任医师实施手术。观察指标:(1)手术操作情况。(2)实验动物术前及术后生理、生化指标。(3)实验终点指标。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。
    (1)手术操作情况。6只实验动物行ERCP中,十二指肠镜从食管开口到通过幽门所需时间为151(46~227)s,通过幽门时的镜身长度为85(80~90)cm,镜身拉直长度为47(45~50)cm;胆管插管过程中,总插管次数为2.0(1.0~3.0)次,成功插管次数为1.5(1.0~2.0)次,成功插管时间为44(13~80)s;胰管插管过程中,总插管次数为3.0(1.0~8.0)次,均只有1次成功插管,成功插管时间为100(53~320)s。(2)实验动物术前及术后生理、生化指标。6只实验动物术前体温为(38.8±0.1)℃、血清淀粉酶为(55.3±0.2)U/dL、血清脂肪酶为232.9(29.4~547.3)U/L、丙氨酸转氨酶为(51±10)U/L、天冬氨酸转氨酶为(38±12)U/L、总胆红素为(3.2±0.7)μmol/L;术后24 h,上述指标分别为(38.6±0.1)℃、(53.0±6.0)U/dL、62.4(29.4~94.1)U/L、(54±5)U/L、(67±27)U/L、(3.5±1.9)μmol/L。(3)实验终点指标。术后14 d实验终点时,6只实验动物胆管长度为(8.6±1.2)cm,胆管内径为(2.5±0.5)mm,胰管长度为12.9(3.7~20.8)cm,胰管内径为(1.6±0.2)mm。组织病理学检查结果显示:实验动物术后14 d实验终点时胆管及周围肝组织和胰管及周围胰腺组织中的CD3和CD68染色均为阴性。
    巴马小型猪模型可应用于ERCP培训。

     

    Abstract:
    Objective To investigate the application value of Bama miniature pig model in endoscopic retrograde cholangiopancreatography (ERCP) training.
    Methods The experimental study was conducted. Six Bama miniature pigs were selected to establish animal model for ERCP operation. The experimental equipments were the EP‑6000 image processing system and ED‑580T therapeutic duodenoscopy, and the surgery was performed by two experienced chief physicians. Observation indicators: (1) surgical operation status; (2) preoperative and postoperative physiological and biochemical indicators of experimental animals; (3) experimental endpoint indicators. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers.
    Results (1) Surgical operation status. During the operation, the time required for the duodenoscope to pass from the esophageal inlet to the pylorus of the six experimental animals was 151(range, 46-227)seconds, the insertion length of the endoscope at the pylorus was 85(range, 80-90)cm, and the straightened length of the endoscope shaft was 47(range, 45-50)cm. For bile duct cannulation, the total number of cannulation attempts was 2.0(range, 1.0-3.0), the number of successful cannulation was 1.5(range, 1.0-2.0), and the time of successful cannulation was 44(range, 13-80)seconds. For pancreatic duct cannulation, the total number of cannulation attempts was 3.0(range, 1.0-8.0), and only one successful intubation was performed for each experimental animal, with the time of successful cannulation as 100(range, 53-320)seconds. (2) Preoperative and postoperative physiological and biochemical indicators of experimental animals. For six experimental animals, the preoperative body temperature was (38.8±0.1)℃, serum amylase was (55.3±0.2)U/dL, serum lipase was 232.9(range, 29.4-547.3)U/L, alanine aminotransferase was (51±10)U/L, aspartate aminotransferase was (38±12)U/L, and total bilirubin was (3.2±0.7)μmol/L. At 24 hours postoperatively, the body temperature was (38.6±0.1)℃, serum amylase was (53.0±6.0)U/dL, serum lipase was 62.4(range, 29.4-94.1)U/L, alanine amino-transferase was (54±5)U/L, aspartate aminotransferase was (67±27)U/L, and total bilirubin was (3.5±1.9)μmol/L. (3) Experimental endpoint indicators. At the experimental endpoint of 14 days after surgery, the bile duct length in the six experimental animals was (8.6±1.2)cm, and the bile duct inner diameter was (2.5±0.5)mm. The pancreatic duct length was 12.9(range, 3.7-20.8)cm, and the inner diameter was (1.6±0.2)mm. Results of histopathological examination revealed that both CD3 and CD68 staining were negative in the bile duct and surrounding hepatic tissue, as well as in the pancreatic duct and adjacent pancreatic tissue at the experimental endpoint of 14 days after surgery.
    Conclusion Bama miniature pig model can be used for ERCP training.

     

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