可调控回肠内旁路术预防症状性吻合口瘘的作用及机制

The high risk factors of anastomotic leakage was significantly increased because of more and more elderly patients of rectal tumors，preoperative radiotherapy and chemotherapy as well as TME techniques widely carried out. Traditional preventive stoma can reduce the incidence of symptomatic anastomotic leakage. While It carries complications (long-term fistula care, anastomotic stricture, etc)and two-stage surgery for reversal, to overcome these shortcomes, Our group researched and developed the GE Type preventive ileostomy device based on the previous research about preventive stoma experimental supported by National Funds for Youth ,we use the device and optimization techniques, called the new techniques as "Controlled ileum bypass" , which completely bypass the intestinal contents during a certain period required .This study intends to use the device in a pig model of low rectal anastomotic leakage to further understand, compared with traditional preventive colostomy, verifying the efficacy and safety , stating the theoretical mechanisms of Controlled ileum bypass, from the aspects of iconography, colon electrobiology , histology.This study also provides experimental basis so as to lay the foundation for the clinical transformation of this new technology, which may replace the traditional preventive ileum fistula method, with the advantage of preventive ileum fistula, a bypass completely and no need for reversal.

高龄直肠肿瘤患者的增多，术前放化疗、TME技术的广泛开展，吻合口瘘的高危因素也明显增多。预防性造瘘可减少症状性吻合口漏的发生，为解决传统造瘘术后的并发症（长时间瘘口护理、吻合口狭窄等）及需二次手术还纳的问题，本课题组在前一国家青年基金有关预防性造口实验研究的的基础上，研发了GE型预防性回肠造口装置，我们应用该装置并优化技术为自创的"可调控回肠内旁路术"，实现在需要的时限内完全转流肠内容物，本研究拟将该装置及新型技术应用于实验猪吻合口漏模型，通过与传统预防性造瘘进行对比研究，求证新型"可调控回肠内旁路术"的有效性与安全性，并从影像学、结肠生物电学、组织愈合学，阐明"可调控回肠内旁路术"预防症状性吻合口瘘的理论机制，为这种既能预防症状性吻合口瘘，又能减少吻合口并发症，同时又无需二次手术还纳的新型技术替代传统的造瘘术提供实验依据，并为这项新型技术的临床转化奠定基础。

吻合口漏一直是中低位直肠癌保肛术后令人担心而常见的并发症，传统预防性造瘘是目前预防症状性漏最有效的办法，但同样增加造瘘相关并发症（如低位吻合口狭窄，肠造口并发症 及二次还纳手术等）。本课题组在国家自然基金“可调控回肠内旁路术预防症状性吻合口漏”中提出了一种替代传统造瘘术的新型技术，但在研究过程中发现：置放造瘘装置时需切开末端回肠，额外增加一吻合口；经装置完全转流时间短于吻合材料的降解时间；可控调节过程中气囊压迫回盲瓣有致粘膜坏死可能等这些不足。并试图从方法学和材料学两方面对上述造瘘方法进行了革新，大量的体内、外实验验证新方法的可行性与有效性，指出通过改变固定方式来固定肠内装置基本无效！肠内装置降解时间不决定转流时间！这种造瘘方式可能是筛选出部分传统造瘘永久不能还纳的新方法！对早期改进这部分患者的治疗非常重要。在microRNA介导结直肠癌发生及其分子基础研究方面也做了一定工作，并取得一定成果。其中发现了微小RNA的一个新的靶基因SMAD4，并阐述了结直肠癌发生发展密切相关的miR-224—SMAD4轴，为结直肠癌治疗提供了新的靶点。