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…     

小肠浆肌层吻合与二层吻合的临床随机对照研究

目的 评估浆肌层吻合在小肠吻合中的安全性和有效性.方法 行胆管(或胰腺假性囊肿)空肠Roux-en-Y吻合的患者随机分成2组: 浆肌层吻合组(n=20)和二层吻合组(n=20),浆肌层吻合组行Roux-en-Y袢处空肠-空肠浆肌层吻合,二层吻合组行Roux-en-Y袢处空肠-空肠二层吻合.术后观察与肠吻合相关的并发症(小肠吻合口漏、狭窄、梗阻和出血)发生情况、肠道恢复排气时间等.结果 2组患者术后均未出现与肠吻合相关的并发症;浆肌层吻合组术后肠道恢复排气时间为(3.6±1.2) d,二层吻合组为(3.6±0.9) d,2组间差异无统计学意义(P>0.05).结论 小肠浆肌层吻合是一种安全有效的吻合方法 .     

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。     

结肠肛管吻合术两层吻合方法的观察

用狗做结肠肛管吻合术，对照组按ＰａｒＲＳ方法行结肠肛管套式吻合，试验组同前吻合后在吻合口上方０．８ｃｍ处再行第二层缝合。术后１、２、８周处死动物，肉眼及光镜检查吻合口。两组各５条狗中对照组发生吻合口漏２例，而试验组吻合口均愈合良好。离体抗张测验两种吻合方法有显著性差异。结果说明两层吻合方法增加了吻合口抗张能力，而对血供无影响，可有效地防止吻合口漏。     

Single-Layer Continuous Suturing for End-to-End Colonic Anastomosis Using a Modified Closed-Bowel Technique

We describe our modified technique of performing one-layer continuously sutured colonic anastomosis, which we introduced in 1995. We also present the preliminary results of performing end-to-end intra-abdominal colonic anastomosis constructed by single-layer continuous suturing using the closed-bowel technique in 106 patients. Mortality was 2.8%, the incidence of early postoperative surgical complications was 3.8% [including anastomotic leakages (1.9%)], and the rate of reoperation for infective complications was 2.8%. These positive results show that this is an effective method of performing end-to-end colonic anastomosis. We think that our technical modification provides advantages for one-layer continuously sutured colonic anastomosis.     

Continuous Suture of a Single Absorbable Suture: A New Simplified Vesicourethral Anastomosis Technique in Laparoscopic Radical Prostatectomy

The purpose of this study was to describe a new simplified technique for facilitating vesicourethral anastomosis in laparoscopic radical prostatectomy. After prostate removal, an approximately 15-cm-long absorbable suture with one three-eighths arc needle is passed from the outside in on the full thickness of the bladder neck at the 9 o''clock position and then from inside out on the full thickness of the urethra at the 9 o''clock position. It is knotted with the suture tail. Subsequently, a continuous suture is completed between the bladder neck and urethra. A 20-French silastic catheter is placed into the bladder before completing the anterior row of sutures. Three hundred twelve consecutive patients with localized prostate cancer who had undergone the new simplified vesicourethral anastomosis were included in this retrospective study. The average time of anastomosis was 10.5 minutes (range, 8–30 minutes), as recorded for an experienced laparoscopic surgeon. The incidence rate was 2.2% for urine leakage and 1.3% for bladder neck stenosis, and the continence rate was 86.9% at 1 month, 93.3% at 3 months, 98.1% at 6 months, and 98.7% at 1 year. We present a new simplified method for vesicourethral anastomosis. The method takes little operating time and is easy for novice laparoscopists to master. Moreover, this technique has low rates of urinary leakage and bladder neck stricture.Key Words: Continuous suture, Laparoscopic radical prostatectomy, Vesicourethral anastomosisLaparoscopic radical prostatectomy (LRP) was first introduced by Schuessler in 1992.¹ It has been proven to be comparable with open radical prostatectomy. However, the technique is a challenge for most urologists, especially given the difficult and time-consuming step of performing urethrovesical anastomosis.^2–3 Initially, many surgeons adopted an interrupted suture requiring 6 to 10 knots.² Van Velthoven et al then reported an anastomosis technique⁴ that has become widely used because of its low rates of urinary leakage and bladder neck stricture. However, the average time of Van Velthoven anastomosis still lasted 35 minutes when it was reported for the first time in 2003.⁴Since 2006, in order to further simplify the surgical procedure and reduce the operating time, we have developed a simpler continuous suture technique that uses only a single absorbable suture with 1 needle, can be more easily mastered, and requires less operating time. We describe this technique and present functional outcomes and incidence rates of complications compared with other reported LRP series applying conventional Van Velthoven anastomosis.