目的 比較胃腸道漿肌層吻合、黏膜外吻合、一層吻合和二層吻合對吻合愈合的影響。
方法 家兔分成4組,即漿肌層吻合組、二層吻合組、一層吻合組和黏膜外吻合組。每組10只,每只動物行1個胃十二指腸側(cè)側(cè)吻合、2個回腸端端吻合和2個結(jié)腸端端吻合。術(shù)后第3和7 d,每組分別各取5只動物,測定吻合破裂壓(ABP)、組織羥脯氨酸(HP)含量并做病理檢查。
結(jié)果 術(shù)后第3 d,各組ABP間差異無統(tǒng)計學意義(P gt;0.05)。術(shù)后第7 d, 二層吻合、一層吻合和黏膜外吻合的ABP間差異無統(tǒng)計學意義(P gt;0.05); 胃十二指腸漿肌層吻合的ABP高于二層吻合和一層吻合(P<0.05); 回腸漿肌層吻合的ABP高于二層吻合(P<0.01); 結(jié)腸漿肌層吻合的ABP高于二層吻合、一層吻合和黏膜外吻合(P<0.05)。術(shù)后第3 d,胃十二指腸和回腸吻合的各組HP含量無明顯差異,結(jié)腸二層吻合HP含量高于一層吻合(P<0.05); 術(shù)后第7 d回腸、結(jié)腸吻合的各組HP含量差異無統(tǒng)計學意義(P gt;0.05), 胃十二指腸漿肌層吻合HP含量高于二層吻合(P<0.025)。術(shù)后第3 d,胃十二指腸和回腸吻合的各組炎癥程度相似,結(jié)腸黏膜外吻合的炎癥反應(yīng)輕于二層吻合(P<0.05); 術(shù)后第7 d,胃十二指腸和結(jié)腸吻合的各組炎癥程度相似,回腸漿肌層吻合炎癥反應(yīng)輕于二層吻合(P<0.05)。術(shù)后第7 d,胃腸道吻合各組黏膜愈合指數(shù)差異無統(tǒng)計學意義(P gt;0.05)。
結(jié)論 胃腸道漿肌層吻合和其他手工吻合一樣安全可靠,但更加簡便。
引用本文: 黃從云,王建南,彭淑牖,張濤,李秉健,徐立. 胃腸道漿肌層吻合、黏膜外吻合、一層吻合和二層吻合的實驗比較研究. 中國普外基礎(chǔ)與臨床雜志, 2007, 14(4): 432-436. doi: 復制
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- 1. 黃從云, 彭淑牖. 胃腸道吻合沿革 [J] . 中華胃腸外科雜志, 2005; 8(6)∶545.
- 2. Leslie A, Steele RJ. The interrupted serosubmucosal anastomosis-still the gold standard [J] . Colorectal Dis, 2003; 5(4)∶362.
- 3. Kuzu MA, Koksoy C, Kale IT, et al. Reperfusion injury delays healing of intestinal anastomosis in a rat [J] . Am J Surg, 1998; 176(4)∶348.
- 4. 孔璐, 王繼峰, 周子悅, 等. 堿解法測定組織羥脯氨酸的實驗研究 [J] . 中國骨質(zhì)疏松雜志, 2003; 9(4)∶319.
- 5. Polat C, Arikan Y, Vatansev C, et al. The effects of increased intraabdominal pressure on colonic anastomoses [J] . Surg Endosc, 2002; 16(9)∶1314.
- 6. Durmus M, Karaaslan E, Ozturk E, et al. The effects of single-dose dexamethasone on wound healing in rats [J] . Anesth Analg, 2003; 97(5)∶1377.
- 7. Witte MB, Barbul A. Repair of full-thickness bowel injury [J] . Crit Care Med, 2003; 31(8 Suppl)∶S538.
- 8. 黃從云, 彭淑牖. 腸道吻合愈合研究進展 [J] . 國外醫(yī)學·外科學分冊, 2005; 32(2)∶114.
- 9. Gottrup F. Oxygen, wound healing and the development of infection. Present status [J] . Eur J Surg, 2002; 168(5)∶260.
- 10. Houdart R, Lavergne A, Valleur P, et al. Vascular evolution of single-layer end-on colonic anastomosis. A microangiographic study of 180 anastomoses in the rat from two to 180 days [J] . Dis Colon Rectum, 1985; 28(7)∶475.
- 11. Jansen A, Becker AE, Brummelkamp WH, et al. The importance of the apposition of the submucosal intestinal layers for primary wound healing of intestinal anastomosis [J] . Surg Gynecol Obstet, 1981; 152(1)∶51.
- 12. Shikata S, Yamagishi H, Taji Y, et al. Single-versus two-layer intestinal anastomosis: a meta-analysis of randomized controlled trials [J] . BMC Surg, 2006; 6(1)∶2.