Esophageal transection using a biofragmentable anastomosis ring in dogs

Since the first publication on the new anastomosis technique using a biofragmentable anastomosis ring (BAR) by Hardy in 1985, various studies have been performed to investigate the superiority of this type of anastomosis, and it has since been reported that the BAR was safely used not only in large and small bowel anastomosis, but in cholecystojejunal and gastrojejunal anastomosis as well. In this study, the feasibility of the BAR for esophageal transection was investigated. Seven dogs were operated on, and one died of intraabdominal bleeding on the operative day while another died of leakage at the site of gastrotomy on the 3rd postoperative day. These deaths were all considered to be due to simple technical errors not directly related to the use of the BAR. The postoperative recovery of the other five dogs was uneventful, and the ring eventually disintegrated into several small fragments that passed out of the body in the faces between the 14th and 21st postoperative days. The dogs were killed on the 28th postoperative day, and both gross and histological examinations, revealed that the transection had been successful. Neither leakage nor significant stenosis at the site of transection was found. Our results suggested that the BAR could be used for esophageal transection and is thus recommended as an easy-to-learn, time-saving, and safe technique for esophageal operations.     

肠道吻合术中应用生物降解吻合环的临床疗效观察

目的探讨肠道吻合术中使用生物降解吻合环的临床疗效。方法回顾性分析本组2003年9月至2006年12月90例肠道吻合术中使用生物降解吻合环的临床资料。结果90例中包括小肠-小肠端端吻合术3例,回肠端端吻合术62例,结肠-结肠端端吻合术15例,结肠-直肠端端吻合术10例。全部吻合过程顺利,术后无吻合口出血及狭窄和吻合口漏,无手术死亡。结论应用生物降解吻合环进行肠吻合术具有安全可靠,操作方便,节省时间,有效预防手术后并发症等优点。     

可吸收吻合环在老年大肠手术中应用的前瞻随机性研究

目的探讨生物可吸收吻合环在老年肠道手术中的应用价值。方法将我院近3年收治的182例老年大肠手术患者随机分为吻合环与缝线组、吻合环与吻合器组，比较手术时间、术后肠功能恢复时间、住院时间及术后并发症等情况，并作统计学分析。结果手术时间吻合环比缝线组明显缩短，而和吻合器组无显著差别，吻合环组患者肠功能恢复时间均较快，总的并发症发生率明显下降。结论生物可吸收吻合环在老年大肠手术中的具有较高的临床应用价值，可作为老年大肠手术常规的吻合方法。     

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目的　评价可分解吻合环 (BAR)在肠道吻合手术中的应用。方法　前瞻性对照研究将 2 0 0 1年 11月至 2 0 0 4年 2月收治的 131例行肠吻合术的病例分为两组 ,吻合环组 (BAR组 ) 6 7例 ,手工缝合组 6 4例。术后分别记录肠道功能恢复时间 ,与吻合口有关的并发症发生等。 92例结、直肠癌中 89例 (BAR组 4 5例 ,手工缝合组4 4例 )术后随访时观察吻合口炎症发生情况。另外 ,BAR组记录BAR排出时间。两组病例一般资料分布均衡。结果　BAR组死亡 1例 ,但与手术无关。BAR组未发生术后吻合口瘘 ,手工缝合组发生 2例 (3 12 % ) ;BAR组未发生吻合口出血和梗阻 ,手工缝合组发生 2例 (3 12 % ) ,两组间差异无显著性 (P >0 0 5 )。术后肠道功能恢复时间 :BAR组 (2 7 2± 5 6 )h ,手工缝合组 (4 9 6± 8 7)h ,两组间差异有显著性 (P <0 0 1)。BAR组发生吻合口炎症 1例 (2 2 2 % ) ,手工缝合组 11例 (2 5 0 0 % ) ,两组间差异有显著性 (P <0 0 1)。术后吻合环排出时间为(12 4± 6 9)d。结论　BAR是一种安全有效 ,可标准化的肠道吻合方法 ,特别是对急诊的高危病例     

可分解吻合环和手工缝合在肠道吻合中的应用对照研究

目的 比较可分解吻合环（BAR）与常规手工缝合在肠道吻合手术中的应用价值。方法 对我院2001年12月至2007年12月收治行肠切除并吻和180例病例采用两种手术方法并分为两组,其中吻合环组（BAR组）92例,手工缝合组88例。术后分别记录肠道功能恢复时间,与吻合口有关的并发症发生等情况。结果 BAR组死亡1例,但与手术无关。BAR组有1例发生术后吻合口瘘,手工缝合组2例,BAR组发生不完全性吻合口梗阻7例。手工缝合组2例,两组间有显著性差异（P〈0．05）。术后肠道功能恢复时间分别为BAR组27．2±5．6h,手工缝合组49．6±8．7h,两组间存在显著性差异（P〈0．01）。吻合口炎症发生情况BAR组1例,手工缝合组11例。两组间有显著性差异（P〈0．01）。结论 BAR是一种安全有效,可标准化的肠道吻合方法,特别是对急诊的高危病例。     

Sutureless anastomosis of blood vessels using cyanoacrylate adhesives

On the assumption that the remaining suture threads of the anastomotic line play an important role in the progression of anastomotic neointimal hyperplasia, we performed an experimental study on the sutureless anastomosis of blood vessels. An expanded polytetrafluoroethylene graft, 5 mm in diameter and 2 cm in length, was implanted on the abdominal aorta of mongrel adult using one of three methods of anastomosis, namely; a continuous suture, a stay suture, or sutureless anastomosis. Overall patency rates were 83.3 per cent, 91.7 per cent and 75.0 per cent respectively. The thickness of the pannus in the distal anastomotic line after 12 months was 107 m in one graft in the continuous suture group, 106 m and 222 m in 2 grafts each in the stay suture group, and 41 m and 117 m in 2 grafts each in the sutureless group. Because there were cases of patency even after 12 months with a very small pannus thickness, sutureless anastomosis is considered to be a useful method of preventing anastomotic neointimal hyperplasia.     

胃癌全胃切除术应用管状吻合器和生物吻合环重建消化道的体会

目的　介绍管状吻合器和生物吻合环在胃癌全胃切除术中消化道重建中的应用体会。方法　全胃切除术中用Roux -Y方式重建消化道 ,其中食管空肠吻合由吻合器完成 ,而空肠间端侧吻合由手工缝合或用可降解吻合环完成。结果　本组 5 6例食管空肠对端吻合及空肠端侧吻合均获一次性成功 ,无手术死亡 ,无吻合口漏。手术时间 90～ 3 10min ,平均 160min。用吻合环完成空肠端侧吻合者平均手术时间仅为 13 0min。术后 6～ 12个月随诊胃镜或钡餐检查 ,5 4例吻合口愈合良好 ,仅 2例出现吻合口狭窄 ,并通过气囊扩张后症状明显改善。结论　在全胃切除术消化道重建中 ,应用吻合器和吻合环作吻合有方便、快捷、可靠等优点 ,有利于防止吻合口漏等并发症。只要患者经济条件允许 ,尽量采用一次性吻合器和吻合环重建消化道。     

生物降解吻合环在108例肠道吻合术中的应用

目的探讨生物降解吻合环在肠道吻合术中的应用价值。方法回顾性分析2002年1月至2005年11月108例使用吻合环行不同肠吻合术患者的临床资料。结果108例中行小肠-小肠端端吻合术2例，回肠-结肠端端吻合术74例，结肠-结肠端端吻合术23例，结肠-直肠端端吻合术9例。2例因小肠肠管的直径太小致吻合失败，106例吻合过程顺利。术后发生吻合口漏2例，占1．8％。术后无吻合口出血及吻合口狭窄，无手术死亡。结论肠吻合术时使用吻合环具有操作简便快捷，效果安全可靠等优点。     

Sutureless large bowel anastomosis: European experience with the biofragmentable anastomosis ring

Sutureless colonic anastomosis using a biofragmentable anastomosis ring (BAR) has been evaluated in a prospective randomized comparison with sutures and staples for elective colorectal surgery. One hundred and one patients underwent BAR anastomosis, 85 a sutured anastomosis, and 16 a stapled anastomosis. There were two anastomotic leaks in the patients undergoing BAR anastomosis, seven in patients having a sutured anastomosis, and one in a patient who had a stapled anastomosis. Wound infection occurred in ten BAR patients, ten sutured patients and no stapled patient. There was no statistically significant difference in these or in other postoperative complications between the groups. The BAR was easy to use and is a safe alternative to sutures and staples for large bowel anastomosis.     

加压吻合环：一项结直肠吻合新技术

目的 评价用一种新型镍钛记忆合金加压吻合环（CAR27）进行结直肠吻合的安全性和有效性.方法 2009年11月12日,采用镍钛记忆合金加压吻合环（CAR27）对1例行直肠高位切除术的乙状结肠癌患者进行结直肠端端吻合.结果 本例手术时间42 min,其中吻合时间11 min,术后第1天肛门即排气,术后第2天开始进食.CAR27吻合环于术后第10天随粪便中排出.患者术后随访1个月,无感染、肠梗阻、吻合口狭窄或瘘等并发症发生.结论 本例研究初步提示,采用镍钛记忆合金加压吻合环进行结直肠吻合安全、可行.     

应用镍钛记忆合金加压吻合环进行肠道吻合的前瞻性研究

目的 探讨应用一种新型镍钛记忆合金加压吻合环(CAR)进行结直肠癌手术肠道吻合的可行性和安全性.方法 前瞻性随机对照分析2010年5月至12月福建医科大学附属第一医院收治的83例行肠道吻合的结直肠癌患者的临床资料.将患者按随机数字表法分成CAR组(41例)和金属钉吻合器组(42例),分别采用CAR或金属钉吻合器行肠道吻合,观察两组患者手术时间、术后肛门排气及排便时间、住院时间、术后愈合情况、术后有无与吻合相关的并发症发生,CAR组患者吻合环的排出时间等.计量资料采用t检验,计数资料采用x2检验.结果 CAR组和金属钉吻合器组患者的平均手术时间分别为( 122±25) min和(128±30) min;吻合口瘘发生率分别为5％ (2/41)和7％ (3/42),吻合口瘘患者经行手术或保守治疗痊愈;两组患者平均手术时间,术后肛门排气、排便时间,住院时间及吻合口瘘发生率比较,差异均无统计学意义(t=1.299,0.756,1.636,0.974,x2=0.165,P＞0.05).CAR组患者于术后9～14 d随粪便排出吻合环,术后未发生吻合口狭窄;金属钉吻合器组患者吻合口狭窄发生率为2％( 1/42),两组比较,差异无统计学意义(x2 =0.988,P＞0.05).CAR组患者术后吻合口平滑、完整、愈合良好;金属钉吻合器组患者可见吻合钉残留存吻合口,并有1例形成炎性息肉.结论 使用CAR行结直肠癌手术肠道吻合是一种简便且安全有效的方法.     

国产非吸收可崩解肠道吻合器在肠道吻合手术中的安全性和有效性评价

目的探讨国产非吸收可崩解肠道吻合器在肠道吻合手术应用中的有效性及安全性．方法前瞻性选取自2010年2月至2011年4月期间于广州市第一人民医院和浙江大学附属第一医院行肠道吻合手术的患者134例．利用SPSS软件生成随机数,按照完全随机原则将患者分为两组,对照组（67例）使用美国产Valtrac生物可降解吻合环,试验组（67例）使用国产非吸收可崩解肠道吻合器。对两种吻合环的操作性能和体内崩解情况以及患者术后生命体征、消化道功能和并发症发生情况进行比较。结果两种吻合环在手术过程中均具有良好的操作性能。操作性能评价得分均为满分（P〉0．05）。两组患者术后体温、血压、心率以及消化道功能和吻合环崩解情况比较,差异均无统计学意义（P〉0．05）,两组患者均未出现并发症。结论国产非吸收可崩解肠道吻合器与美国产吻合环在肠道吻合手术中具备相似的安全性与有效性。     

A 10-year single-institutional study of the biofragmentable anastomosis ring

BACKGROUND: The biofragmentable anastomosis ring (BAR) was introduced by Hardy in 1985 as a simple alternative to sutured or stapled intestinal anastomosis. METHODS: The aim of this study was to analyze complications related to the use of the BAR in elective intraperitoneal intestinal anastomosis to identify technical aspects important in the safe use of the device. The BAR was used by a single surgeon over a 10-year period. Three hundred fifty sequential intraperitoneal anastomoses were performed in 346 patients. There were 12 enteroenteric, 2 gastrojejunal, 199 enterocolic, and 137 colocolic anastomoses. RESULTS: There was 1 suture line recurrent carcinoma but no strictures. There were 11 complications that appeared related to construction of the anastomosis, 2 of them resulting in death. The 2 patients who died both had cirrhosis with ascites. Eight patients required re-exploration for suspected anastomotic complications. Six of them recovered and were discharged. CONCLUSION: The BAR appears to be a safe alternative to sutured or stapled bowel anastomosis provided certain precautions are taken in its use.     

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目的 总结吻合环在结肠癌并发肠梗阻行一期切除吻合中的应用经验。方法 回顾性分析1998～2002年间使用吻合环的30例结肠癌并发肠梗阻行一期切除吻合病人的临床资料。结果 全组术中吻合过程均顺利，无手术死亡，术后吻合漏1例(3．3％)，切口感染5例(16．7％)，无吻合口狭窄。结论 吻合环在结肠癌并发肠梗阻手术的应用中具有简单、安全、省时等优点，是提高吻合成功率、减少并发症发生的有效方法之一。     

生物降解吻合环在腹腔镜右半结肠切除术中的应用

目的探讨生物降解吻合环在腹腔镜右半结肠切除术中的应用价值。方法将生物降解吻合环应用于40例腹腔镜右半结肠切除术中,其中手术的消化道重建使用腹腔外吻合环回结肠端端吻合法。结果所有患者手术均获成功,术后未发生吻合口瘘、吻合口出血和狭窄。吻合环均在四周内排出体外。术后半年肠镜检查,2例发生吻合口炎症,半年后随访消失。结论在腹腔镜右半结肠切除术中使用生物降解吻合环具有简便、快捷、安全的优点,可在临床上推广使用。     

Gastrointestinal viscerosynthesis with biofragmentable anastomosis ring.

The biofragmentable anastomosis ring (BAR) has been in clinical use since 1987. It yields a standardized intestinal viscerosynthesis leaving no foreign body in the tissues. Several multicentre and single studies have shown its safety and efficacy in elective colonic surgery. Our studies have shown it to be safe and reliable also in small bowel surgery and bilio-digestive anastomosis. Our long-term results in colonic surgery are very promising. A review of anastomosis technique and current literature is given.     

Restoration of myoelectrical propagation across a jejunal transection using microsurgical anastomosis

The aim of this study was to determine whether microsurgical anastomosis can restore propagation of jejunal pacesetter potentials (PPs) across a site of canine jejunal transection and preserve motility and transit in bowel distal to the transection. A complete jejunal transection with exact microsurgical anastomosis was performed in five dogs, while five dogs with intact jejunum and five dogs with complete transection and end-to-end conventional macrosurgical anastomosis were used as controls. Long-term recording electrodes and intraluminal, open-tipped pressure catheters were implanted in all dogs. The mean frequency of PPs decreased distal to the transection in both groups of transected dogs. However, aborad propagation of PPs across the anastomosis occurred episodically by 3 months in each dog that had a microsurgical anastomosis, but never occurred in any dog with a conventional macroanastomosis. Moreover, the motility and transit in bowel distal to the transection were unaltered in the dogs with a microsurgical anastomosis, whereas they decreased in the dogs with a macroanastomosis. The conclusion was that microsurgical anastomosis of transected canine jejunum restored episodic propagation of PPs across the anastomosis, and preserved motility and maintained transit in bowel distal to the anastomosis. The conventional macroanastomosis did none of these. Supported by the Mayo Foundation and the Nigrn Grant. Presented in part at the Thirty-Seventh Annual Meeting of The Society for Surgery of the Alimentary Tract, May 19–22, 1996, San Francisco, Calif.     

加压吻合环应用于直肠低位前切除术的动物实验

目的评价应用镍钛记忆合金加压吻合环（NITICAR27）在直肠低位前切除后进行端端吻合的可行性和安全性。方法6只小型猪行中远端直肠部分肠段切除．应用CAR27经肛门行直肠端端吻合。术后14d时,5只小型猪被实施安乐死;另1只在56d时也行安乐死;进行吻合口距肛缘距离和吻合口腔内周长的测量,并予以病理组织学检查。结果6只小型猪吻合口据肛缘距离平均5．3（4-6）cm;均无吻合口瘘及其他并发症发生,术后恢复顺利,体质量增加。14d时．在离体自然松弛状态下,吻合171腔内周长平均6．8（6．5～7．0）cm．组织病理学检查示有轻度的炎性反应及纤维化;56d时,吻合口腔内周长扩张到9．3cm．组织病理学检查示炎性反应及纤维化消失。吻合口浆膜面除1例轻微黏连外,其余均光滑完整,肉眼几乎不可辨别。结论镍钛记忆合金加压吻合环有希望作为一种新的吻合器械应用于低位直肠前切除术。     

Early experience with biofragmentable anastomosis ring in colon surgery

A biofragmentable anastomosis ring (Valtrac-BAR) was used to construct anastomoses in 20 (group I) consecutive patients (11 women and nine men; mean (SD) age 54.5 (13 years) undergoing elective colonic resection. The results were compared with those of 20 consecutive patients who underwent elective colonic resection in this department during the same period (group II) who had their anastomoses hand-sutured or stapled. There was one death in hospital in each group (5%). There were four anastomotic complications requiring reoperation, leakage (n = 3), and stricture (n = 1) in group I (20%) compared with none in group II. Three patients in each group developed postoperative ileus; these were all initially treated conservatively. In most cases with a ring anastomosis the clinical course was uneventful. We conclude that the biofragmentable ring can be used for different types of colon anastomoses, but so far it has not shown any special advantage over more commonly used anastomotic techniques, and more experience is needed before its routine use can be recommended.     

Sutureless microvascular anastomosis using a neodymium-yag laser

A technique is described in which a Neodymium-YAG laser is used to anastomose arteries 0.8 to 1.0 mm in diameter. Heat generated by the laser causes fusion of the collagen of the media, making direct handling of the vessel wall unnecessary. Four variations of the technique were performed in 120 rat carotid arteries. Angiographic and scanning electron microscopic studies were carried out immediately after surgery and at intervals of 1 day to 6 months after anastomosis. Patency rates as high as 92.5% were recorded. The technique that produced the most secure anastomosis was considered to be one in which a vascular strut was used as an aid in apposition, followed by the application of a piece of vein wall to the anastomosis with tissue adhesive. The main advantages of the laser technique are speed and consistency. Complications such as disruption and aneurysm formation are considered to be rare.