新型原位植入式人工肛门括约肌样机及离体肠道实验研究

doi:10.3969/j.issn.0258-8021.2012.06.007

摘要
图/表
参考文献
相关文章 (0)

全文: PDF (672 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要设计一款基于生物信号反馈机制的智能化可遥控式人工肛门括约肌系统。所设计的蠕动式微型医用泵在3.3 V 驱动电压下，最大流量为8.5 mL/min，最大封闭压可达170 kPa。新型括约肌假体在较小注水量（9～10.5 mL）的情况下,可实现对肠壁作用压的均匀分布（3.34～7.26 kPa），符合人体肠道生理结构和安全压力阈值的要求，避免由于局部高压导致的缺血性坏死。人工括约肌系统采用体内充电电池、体外无线经皮能量充电的供电方式，实现系统的完全植入式移植。离体实验结果表明，该系统可以有效地抑制肠道内容物渗漏，成功建立排便感知信号，从而为严重肛门失禁、结肠造口等肛门功能严重缺失的患者提供一种人性化的治疗方案。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	克磊^* 颜国正翁晓靖刘华许茜茜

关键词 ：人工肛门括约肌, 括约肌假体, 经皮能量传输, 医用微泵, 生物反馈控制

Abstract：In this paper an intelligent and remote-controlled artificial anal sphincter based on biological signal feedback mechanism for a novel artificial anal sphincter system (AASS) was designed and integrated. The peristaltic mechanical medical micropump transported fluid bidirectional with a maximum flow rate of 8.5 mL/min and built up backpressure up to 170 kPa. The design of the prosthesis reduced the occlusion pressure and allowed low inflation volumes (9～10.5 mL). The operating pressures between 3.34 and 7.26 kPa indicated a minor risk of ischemic injury to the bowel. Furthermore, the operation time was estimated at about 2 days with rechargeable battery based on transcutaneous energy transfer technology. The results of in vitro experiments indicated that the system could control the fecal and build the sense of defecation successfully.This AASS is promising in application for the patients with severe anal dysfunction caused by fecal incontinence or colostomy.

Key words： artificial anal sphincter sphincter muscle prosthesis transcutaneous energy transmission micropump biofeedback control

基金资助: 国家自然科学基金（30800235）;教育部博士点基金新教师基金（20070248094）;上海交通大学“医工（理）”交叉研究基金（YG2009ZD103）

引用本文:

克磊^* 颜国正翁晓靖刘华许茜茜. 新型原位植入式人工肛门括约肌样机及离体肠道实验研究[J]. 中国生物医学工程学报, 2012, 31(6): 846-852.
KE Lei^*YAN Guo Zheng WENG XiaoJing LIU Hua XU QianQian. Assessment and in vitro Experiment of a Novel Implantable Artificial Anal Sphincter Prototype. journal1, 2012, 31(6): 846-852.

链接本文:

http://cjbme.csbme.org/CN/10.3969/j.issn.0258-8021.2012.06.007 或 http://cjbme.csbme.org/CN/Y2012/V31/I6/846

［1］Roos A, Thakar R, Ilczyszyn A, et al. Anal and urinary incontinence in nulliparous womenprevalence and risk factors ［J］. International Urogynecology Journal, 2008, 19:156-157. 
［2］林宏城，苏丹，康亮，等. 人工肛门括约肌的研究进展［J］. 结直肠刚肛门外科, 2009, 15(4): 290-292.
［3］卢震海，万德森. 肠造口手术的并发症及其处理［J］. 广东医学, 2009, 30(8): 1029-1030.
［4］Setti Carraro P, Kamm MA, Nichols RJ. Longterm results of postanal repair for neurogenic faecal incontinence ［J］. Br J Surg, 1994，81:140-144. 
［5］Engel AF, Kamm MA, Hawley PR. Civilian and war injuries of the perineum and anal sphincters ［J］.Br J Surg, 1994，81:1069-1073. 
［6］Pena A. Posterior sagittal anorectoplasty: results in the management of　332　cases of anorectal malformations ［J］. Paediatr Surg Int,1988，3:94-104. ［7］Lehur PA, Roig JV, Duinslaeger M. Artificial anal sphincter: prospective clinical and manometric evaluation［J］. Dis Colon Rectum, 2000, 43:1100-1106.［8］Finlay IG, Richardson W, Hajivassiliou CA. Outcome after implantation of a novel prosthetic anal sphincter in humans［J］. Br J Surg, 2004, 91:1485-1492.［9］Ruiz Carmona MD, Company RA, RoigVila JV, et al. Longterm results of artificial bowel sphincter for the treatment of severe faecal　incontinence. Are they what we hoped for?［J］. Colorectal Disease, 2009, 11： 831-837.
［10］Doll A, Heinrichs M, Goldschmidtboeing F, et al.A high performance bidirectional micropump for a novel artificial sphincter system ［J］. Sens Actuators A Phys, 2006, 130-131:445-453.
［11］Ruthmann O, Richter S, Seifert G, et al. The first teleautomatic lowvoltage prosthesis with multiple therapeutic applications: a new version of the German artificial sphincter system ［J］. Artif Organs, 2010, 34(8): 635-641.
［12］Huang Zonghai, Shi Fujun, Chen Fei, et al. In vitro and in vivo assessment of an intelligent artificial anal sphincter in rabbits ［J］. Artif Organs, 2011, 35(10): 964-948.
［13］Duthie HL. Anal continence ［J］. Gut, 1971, 12： 844-852.
［14］颜国正，刘华，昝鹏，等. 用于人工肛门括约肌的滚轮式医用微型泵［P］. 中国专利:200710045450，20071025.
［15］Gowrishankar TR, Stewart DA, Martin GT, et al. Transport lattice models of heat transport in skin with spatially heterogeneous, temperaturedependent perfusion［J］. BioMed. Eng. Online, 2004, 3:42.
［16］刘华，颜国正，许茜茜，等. 检测柔性肠道压力的生物反馈传感器研制［J］. 中国科技论文在线精品论文, 2011, 23(4): 21602165.
［17］Webmaster. 肛管直肠测压基础知识概述［EB/OL］．http://blog.sina.com.cn/s/blog_6548dc870100hcva.htmL,2008512/2012712
［18］Engelmann UH, Felderman TP, Scontt FB. The use of the AMSAS800 artificial sphincter for continent urinary diversion I. Investigations, including pressureflow studies, using rabbit intestinal loops ［J］. Journal of Urology, 1985, 134： 183-186. 
［19］Engelmann UH, Felderman TP, Scontt FB. Evaluation of AMS 800 artificial sphincter for continent urinary diversion using intestinal loops ［J］. Journal of Urology, 1985, 25： 620-621.
［20］Light JK. Long term clinical results using the artificial urinary sphincter around bowel ［J］. Br J Urol, 1989, 64:56-60.
［21］Hajivassiliou CA, Finlay IG. Effect of a novel prosthetic anal neosphincter on human colonic blood flow ［J］. Br J Surg, 1998, 85:1703-1707.
［22］Johansson K, Ahn H, Lindhagen J. Assessment of smallbowel ischemia by laser Doppler flowmetry. Some case reports ［J］. Scand J Gastroenterol, 1986， 21: 1147-1152.
［23］Wong WD, Congliosi SM, Spencer MP, et al. The safety and efficacy of the artificial bowel sphincter for fecal incontinence ［J］. Dis Colon Rectum, 2002, 45(9):1139-1153.
［24］Wong WD, Jensen LL, Bartolo DCC, et al. Artificial anal sphincter ［J］. Dis Colon Rectum, 1996, 39(12):1345-1351.