回结肠浆肌层吻合与二层吻合的临床研究

目的评估浆肌层吻合在小肠与大肠吻合中的安全性和有效性。方法将需行回肠与横结肠吻合的50例患者按随机数字表法分成2组:浆肌层吻合组(n=25)和二层吻合组(n=25),浆肌层吻合组行回肠末端-横结肠端端浆肌层吻合,二层吻合组行回肠末端-横结肠端端二层吻合,观察并比较2组患者术中吻合时出血量、吻合时间和术后并发症发生率、术后肠道恢复排气时间、排便时间及住院时间。结果浆肌层吻合组与二层吻合组吻合时出血量、术后肠吻合口漏发生率、肠道恢复排气时间、排便时间以及住院时间分别为(11.00±3.24)ml比(10.28±2.99)ml、4.0%比8.0%(、3.72±1.59)d比(5.08±3.36)d、(4.72±1.59)d比(6.08±3.36)d和(8.47±2.32)d比(10.26±2.61)d,2组相比差异均无统计学意义(P>0.05);而浆肌层吻合组吻合时间为(11.74±2.02)min,较二层吻合组的(16.44±2.06)min短,差异有统计学意义(P<0.05)。结论浆肌层吻合在小肠与大肠吻合术中是安全有效的。     

胃肠浆肌层端端吻合和二层吻合的临床比较

吻合口瘘是消化道吻合常见的并发症,与吻合组织血供、黏膜下层对合程度、吻合张力和吻合技术等密切相关。尽管器械吻合、BAR吻合应用逐渐增多,但手工吻合仍是最基本操作。随着对消化道吻合研究的深入,吻合方法也从二层吻合向一层吻合、黏膜外吻合演变[1],方法越来越简便、安全可靠。尽管这些方法优点众多,均缝及或压迫黏膜下层,干扰吻合组织氧供,影响吻合愈合。不缝及黏膜下层的浆肌层吻合报道极少[2],因担心吻合口瘘而采取间断水平褥式内翻吻合。为此,我们进一步简化,采用间断或连续浆肌层端端吻合,通过对BillrothⅠ、Ⅱ式胃肠吻合术患者…     

胃肠道浆肌层吻合、黏膜外吻合、一层吻合和二层吻合的实验比较研究

目的比较胃肠道浆肌层吻合、黏膜外吻合、一层吻合和二层吻合对吻合愈合的影响。方法家兔分成4组,即浆肌层吻合组、二层吻合组、一层吻合组和黏膜外吻合组。每组10只,每只动物行1个胃十二指肠侧侧吻合、2个回肠端端吻合和2个结肠端端吻合。术后第3和7d,每组分别各取5只动物,测定吻合破裂压（ABP）、组织羟脯氨酸（HP）含量并做病理检查。结果术后第3d,各组ABP间差异无统计学意义（P〉0.05）。术后第7d,二层吻合、一层吻合和黏膜外吻合的ABP间差异无统计学意义（P〉0.05）;胃十二指肠浆肌层吻合的ABP高于二层吻合和一层吻合（P〈0.05）;回肠浆肌层吻合的ABP高于二层吻合（P〈0.01）;结肠浆肌层吻合的ABP高于二层吻合、一层吻合和黏膜外吻合（P〈0.05）。术后第3d,胃十二指肠和回肠吻合的各组HP含量无明显差异,结肠二层吻合HP含量高于一层吻合（P〈0.05）;术后第7d回肠、结肠吻合的各组HP含量差异无统计学意义（P〉0.05）,胃十二指肠浆肌层吻合HP含量高于二层吻合（P〈0.025）。术后第3d,胃十二指肠和回肠吻合的各组炎症程度相似,结肠黏膜外吻合的炎症反应轻于二层吻合（P〈0.05）;术后第7d,胃十二指肠和结肠吻合的各组炎症程度相似,回肠浆肌层吻合炎症反应轻于二层吻合（P〈0.05）。术后第7d,胃肠道吻合各组黏膜愈合指数差异无统计学意义（P〉0.05）。结论胃肠道浆肌层吻合和其他手工吻合一样安全可靠,但更加简便。     

胃肠道浆肌层吻合的可行性研究

目的探讨胃肠道浆肌层吻合的可行性。方法中国家兔分成4组，A组（浆肌层吻合）、B组（二层吻合）、C组（一层吻合）和D组（黏膜外吻合），每组10只。每只动物行胃十二指肠侧侧吻合、回肠端端吻合（2个）和结肠端端吻合（2个）。术后测定吻合破裂压、组织羟脯氨酸含量和组织病理学检查。结果（1）术后第3天，A组胃肠道吻合的吻合破裂压、羟脯氨酸含量与B、C、D组差异无统计学意义；（2）第7天，A组吻合破裂压在胃十二指肠吻合中高于B、C组（P〈0．05），回肠吻合中高于B组（P〈0．01），结肠吻合中高于B、C、D组（P〈0．05）；胃十二指肠吻合组织羟脯氨酸含量A组高于B组（P〈0．05），和C、D组差异无统计学意义；（3）A组的炎症反应在胃十二指肠吻合中与B、C、D组相似，回肠吻合中最轻，结肠吻合中与B组相似。结论胃肠道浆肌层吻合是一种安全、可靠，简便的吻合方法。     

胃肠道浆肌层吻合的动物实验

目的探讨胃肠道浆肌层吻合的可行性。方法将中国家兔分成浆肌层吻合组、2层吻合组、1层吻合组和黏膜外吻合组,每组10只。每只家兔行1处吻合胃十二指肠侧侧吻合、2处回肠和2处结肠的端端吻合。术后第3、7天,测定吻合口爆破压(ABP)和羟脯氨酸(HP)含量。结果术后第7天,浆肌层吻合组各吻合口ABP均高于其他3组(P<0.05,P<0.01);HP含量高于2层吻合组(P<0.05)。结论胃肠道浆肌层吻合是一种安全、可靠及简便的方法。     

近端胃切除浆肌瓣吻合的历史及现状

随着早期胃上部癌及食管胃结合部腺癌的检出率逐渐增高,近端胃切除术的安全性得到验证,保功能的近端胃切除术逐步得到广泛应用。然而,近端胃切除破坏了食管胃结合部的正常解剖结构,导致患者术后胃食管反流症状较重,严重影响生活质量。在各种抗反流术式中,重建"贲门-阀门"因与正常抗反流原理类似,一直是相关学者探索的热点。经过多年的发...     

胃浆肌层修复巨大十二指肠溃疡缺损

在于术治疗十二指肠溃疡病时,常因溃疡过大而致十二指肠残端闭合困难,易并发残端瘘。我们于1992～1996年,对所收治的2例十二指肠穿透性溃疡致巨大缺损的病例,采用带血管的胃后壁浆肌层进行修补,获得十分满意的效果。现报告如下。     

食管-胃吻合器吻合与一层吻合的临床比较

目的 比较吻合器吻合与一层内翻缝合法,在食管、贲门癌手术后,吻合口瘘及吻合口狭窄的发生率。方法 １５２例病人使用吻合器,１８６例病人采用一层内翻缝合法,行食管一胃吻合。结果 吻合器吻合的吻合瘘发生率３．９５％,吻合口狭窄发生率９．１７％。一层内翻吻合的吻合口瘘发生率为２．１５％,吻合口狭窄发生率２．６１％。结论 二种吻合方式比较,吻合口瘘发生率无显著性差异,吻合口狭窄发生率有显著性差异。     

Esophageal Suture Anastomosis: An Experimental Study in Piglets

End-to-end suture anastomosis of the entire wall, the mucosal layer and the muscular layers of the esophagus and selective interruption of its mucosa and muscular layers were performed in a series of piglets.

Healing in suture anastomosis of the entire esophageal wall and the mucosa layer alone occurred with varying degrees of tissue fibrosis, which uniformly caused reduction of elasticity at the anastomotic site.

The least extensive fibrosis was encountered in anastomoses involving only the muscular layers. In these instances no reduction of anastomotic width or elasticity could be demonstrated.

Mucosal interruption alone resulted in extensive fibrosis with subsequent complete obliteration of the esophageal lumen. Conversely, interruption of the muscular layers resulted in negligible fibrosis and caused neither organic nor functional obstruction.

The results of this study indicate a relationship between defective mucosal contact or mucosal damage and stricture formation.     

Randomized Controlled Trial of Barbed Polyglyconate Versus Polyglactin Suture for Robot-Assisted Laparoscopic Prostatectomy Anastomosis: Technique and Outcomes

Background

Transperitoneal robot-assisted laparoscopic prostatectomy (RALP) urethrovesical anastomosis is a critical step. Although the prevalence of urine leaks ranges from 4.5% to 7.5% at high-volume RALP centers, urine leaks prolong catheterization and may lead to ileus, peritonitis, and require intervention. Barbed polyglyconate sutures maintain running suture line tension and may be advantageous in RALP anastomosis for reducing this complication.

Objective

To compare barbed polyglyconate and polyglactin 910 (Vicryl, Ethicon, Somerville, NJ, USA) running sutures for RALP anastomosis.

Design, setting, and participants

This was a prospective, randomized, controlled, single-surgeon study comparing RALP anastomosis using either barbed polyglyconate (n = 45) or polyglactin 910 (n = 36) sutures.

Surgical procedure

RALP anastomosis using either barbed polyglyconate or polyglactin 910 sutures was studied.

Measurements

Operative time, cost differential, perioperative complications, and cystogram contrast extravasation by anastomosis suture type were measured.

Results and limitations

Although baseline characteristics and overall operative times were similar, barbed polyglyconate sutures were associated with shorter mean anastomosis times of 9.7 min versus 9.8 min (p = 0.014). In addition, anastomosis with barbed polyglyconate rather than polyglactin 910 sutures was associated with more frequent cystogram extravasation 8 d postoperatively (20.0% vs 2.8%; p = 0.019), longer mean catheterization times (11.1 d vs 8.3 d; p = 0.048), and greater suture costs per case ($51.52 vs $8.44; p < 0.001). After 8 of 29 (27.6%) barbed polyglyconate anastomosis sites demonstrated postoperative day 8 cystogram extravasation, we modified our technique to avoid overtightening, reducing cystogram extravasation to 1 (6.3%) of 16 subsequent barbed polyglyconate anastomosis sites. Potential limitations include small sample size and the single-surgeon study design.

Conclusions

Compared to traditional sutures, barbed polyglyconate is more costly and requires technical modification to avoid overtightening, delayed healing, and longer catheterization time following RALP.     

Evaluation of a Single-layer Intestinal Anastomosis: An Experimental Study

Fifteen single-layer and 15 double-layer inverting intestinal anastomoses were made in the small intestines of is healthy mongrel dogs and the results were compared. The single-layer anastomosis was found to be superior to the double-layer procedure in many respects     

生物可分解吻合环在肠梗阻行肠一期切除吻合术中的应用

为探讨生物可分解吻合环在急诊肠梗阻患者行一期切除吻合术中的应用价值，回顾分析2006-2010年使用生物可分解吻合环行一期切除吻合术的25例急诊肠梗阻患者资料。结果显示，全组术中吻合过程均顺利，无手术死亡，创口感染2例，无吻合口漏、吻合口狭窄发生。结果表明，应用生物可分解吻合环行肠梗阻手术可提高吻合成功率，减少并发症，且操作简单、安全、省时．是一种理想的方法。     

促进化脓性腹膜炎肠吻合愈合的临床研究

目的探索在急性化脓性腹膜炎条件下促进肠吻合或缝合口愈合的措施。方法于1998～2004年选择性地对47例外伤性肠损破或手术后吻合破裂伴有急性化脓性腹膜炎且延误处理48h以上的病人,在剖腹探查、引流的同时,行肠切除吻合或缝合术,辅以大量等渗盐水冲洗腹腔,吻合或缝合口涂喷纤维蛋白胶,放置多根腹腔负压引流管。术后24～48h开始给予重组人生长激素与相应的术后处理。结果术后2例发生吻合口破裂,1例经非手术治疗后愈合;另1例系胃癌术后胃肠吻合口破裂,再次手术后未应用生长激素,非手术治疗无效。全组病人术后除均继续表现有脓毒症外,并发肝功能损害23例(48.9%),肺部感染或急性呼吸窘迫综合征(ARDS)16例(34.0%),肾功能障碍6例(12.8%),除1例死亡外,余均治愈。结论营养支持,感染控制措施的进步,纤维蛋白胶与生长激素的应用,加上术后细致的处理、有效地防治并发症,在急性化脓性腹膜炎条件下肠切除吻合或缝合仍能获得成功。