Magnetic compression anastomosis

磁压缩吻合术
  • 文章类型: Journal Article
    磁压缩吻合术(MCA)是一种为管状器官提供无缝线通道结构的新方法。由于常规内镜治疗的复发率高,手术的致残率和死亡率高,MCA技术显示出希望。这篇综述的目的是全面审查过去几年中有关MCA在不同胃肠道疾病中使用的文献,根据吻合部位对它们进行分类,并详细描述各种磁体输送方法和MCA的临床结果。MCA是一项创新技术,它的使用代表了微创干预领域的进步。比较研究表明,MCA形成的吻合在一般外观和组织学方面与手术缝合线相当或更好。尽管目前的大多数研究都涉及动物研究或小种群研究,初步论证了MCA的安全性和可行性。仍然需要涉及人群的大型前瞻性研究来保证MCA的安全。对于最初在临床环境中使用的技术,还应采取有效措施,甚至预防,并发症。此外,必须在这个新兴领域创建和优化特定的商业磁体。
    Magnetic compression anastomosis (MCA) is a new method that provides sutureless passage construction for tubular organs. Due to the high recurrence rate of conventional endoscopic treatment and the high morbidity and mortality of surgical procedures, the MCA technique shows promise. The aim of this review is to comprehensively examine the literature related to the use of MCA in different gastrointestinal diseases over the past few years, categorizing them according to the anastomotic site and describing in detail the various methods of magnet delivery and the clinical outcomes of MCA. MCA is an innovative technique, and its use represents an advancement in the field of minimally invasive interventions. Comparison studies have shown that the anastomosis formed by MCA is comparable to or better than surgical sutures in terms of general appearance and histology. Although most of the current research has involved animal studies or studies with small populations, the safety and feasibility of MCA have been preliminarily demonstrated. Large prospective studies involving populations are still needed to guarantee the security of MCA. For technologies that have been initially used in clinical settings, effective measures should also be implemented to identify, even prevent, complications. Furthermore, specific commercial magnets must be created and optimized in this emerging area.
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  • 文章类型: Systematic Review
    背景:磁压缩吻合术(MCA)是长间隙食管闭锁(EA)患者的替代技术。它允许保存天然食道。我们旨在系统地总结当前有关EA中MCA的文献。方法:包括使用MCA设备治疗EA新生儿的研究,而食管狭窄的研究被排除。所有的临床研究,包括比较研究,案例系列,和病例报告,有资格列入。使用经过验证的工具进行方法学质量评估。结果:12项研究共42例患者纳入本综述。关于开始MCA的时间(1天至7个月),这些研究之间存在很大差异。手术时间(13-320分钟),和磁铁特性(强度,尺寸,和所用磁铁的形状)。实现吻合的时间为1至12天。几乎所有患者都有吻合口狭窄的报道,需要多次内窥镜扩张(中位数扩张/患者=9.8)。9例(21%)患者需要支架置入治疗难治性狭窄,6例(14%)患者需要手术治疗狭窄。仅在4项研究中报道了长期结果包括食管运动障碍(n=3)和复发性肺部感染(n=3)。结论:根据本综述的结果,接受MCA的长间隙EA的新生儿总是需要多次内窥镜扩张(中位数扩张/患者=9.8)。此外,纳入的研究在MCA程序方面存在很大差异.需要采用标准化程序来实现MCA的未来研究,以确定该脆弱患者群体的其他结果。
    Background: Magnetic compression anastomosis (MCA) is an alternative technique for patients with long-gap esophageal atresia (EA). It allows for preservation of the native esophagus. We aimed to systematically summarize the current literature on MCA in EA. Methods: Studies where neonates with EA were treated with MCA devices were included, while studies on esophageal stenosis were excluded. All clinical studies, including comparative studies, case series, and case reports, were eligible for inclusion. Methodological quality assessment was performed using a validated tool. Results: Twelve studies with a total of 42 patients were included in this review. There was a wide variation among these studies with regard to the time of initiation of MCA (1 day to 7 months), procedure time (13-320 minutes), and magnet characteristics (strength, size, and shape of the magnets used). The time to achieve anastomosis ranged from 1 to 12 days. Stricture at the anastomotic site was reported in almost all the patients, which required multiple endoscopic dilatations (median no. of dilatations/patient = 9.8). Stent placement for refractory stricture was required in 9 (21%) patients, and surgery for stricture was required in 6 (14%) patients. Long-term outcomes included esophageal dysmotility (n = 3) and recurrent pulmonary infections (n = 3) were reported in only four studies. Conclusion: As per the findings of this review, neonates with long-gap EA undergoing MCA would invariably require multiple sittings of endoscopic dilatations (median no. of dilatations/patient = 9.8). Also, there is a wide variation among the included studies in terms of the procedure of MCA. Future studies with a standardized procedure for achieving MCA are needed to determine additional outcomes in this fragile patient population.
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