术后早期进食对兔胃肠吻合口瘘的形成及愈合时间的影响

摘 要］ 目的：动态观察术后早期进食对兔胃肠吻合口愈合的影响，初步阐明胃肠道手术术后早期进食与兔胃肠吻合口瘘的形成及愈合时间的关系。方法：将48只家兔随机分为实验组与对照组，每组24只，均行胃肠吻合术，实验组家兔于术后24 h进全流食，对照组家兔术后全程禁食水，予以静脉提供能量。分别于术后36 h、72 h、5 d、7 d、10 d和15 d每组取2只家兔行剖腹探查，观察2组家兔吻合口愈合率、吻合口破裂压力、吻合口抗张力强度和吻合口羟脯氨酸水平。结果：对照组家兔吻合口愈合率为91.6%（22/24），实验组家兔吻合口愈合率为95.8%（23/24），2组家兔吻合口愈合率比较差异无统计学意义（P>0.05）；术后72 h 2组吻合口破裂压力明显降低，为各自最低值，术后5 d 2组吻合口破裂压力明显上升，实验组破裂压力略低于对照组，术后7 d对照组达到峰值，术后10 d对照组破裂压力较术后7 d略微下降，实验组此时达到峰值，各时间点2组吻合口破裂压力比较差异无统计学意义（P>0.05）；术后72 h 2组吻合口抗张力强度差异不明显，2组均达到最低值。术后10 d 2组吻合口抗张力强度均显著上升，达到各自最大值，各时间点2组间吻合口抗张力强度比较差异无统计学意义（P>0.05）；术后72 h实验组吻合口羟脯氨酸水平略低于对照组，术后7 d 2组均达到峰值，各时间点2组间吻合口羟脯氨酸水平比较差异无统计学意义（P>0.05）。结论：术后早期进食不会延长吻合口的愈合时间，不会增加吻合口瘘发生的几率。

Influnece of early postoperative feeding in formation of gastrointestinal anastomotic fistula and healing time in rabbits

Objective To observe the influence of early postoperative feeding in the healing of intestinal anastomosis in rabbits,and to clarify preliminarily the relationships between early postoperative feeding after gastrointestinal surgery and gastrointestinal anastomotic fistula formation and healing time in rabbits.Methods 48rabbits were randomly divided into experimental group and control group,then they were treated with gastrointestinal anastomosis.The rabbits in experimental group were fed with liquid diet 24hafter operation,and the rabbits in control group were fed nothing after operation and supplied by total parenteral nutrition.Two rabbits of each group were selected for exploratory laparotomy on the 3rd,5th,7th,10th and 15th day after operation,and the healing rate of anastomosis,the anastomotic bursting pressure,the anastomotic breaking strength,and the hychoxyproline level of anastomosis were observed.Results The healing rate of anastomosis in control group was 91.6%(22/24), and the healing rate of anastomosis in experimental group was 95.8%(23/24),there was no significant difference between two groups(P>0.05).The anastomotic bursting pressures of the rabbits in two groups were decreased remarkably at the 72nd hour after operation,which was the lowest point,and they were increased remarkably on the 5th day after operation,but the anastomic bursting pressure in experimental group was a little lower than that in control group,and it reached the peak on the 7th day after operation in control group.On the 10th day after operation,the anastomic bursting pressure in control group was a little lower than that on the 7th day after operation,but the anastomic bursting pressure in experimental group reached the peak.There were no significant differences of anastomic bursting pressure at different time points between two groups(P>0.05).The anastomotic breaking strength had no significant difference between two groups at the 72nd hour after operation,both of them reached the lowest points,however the anastomtic breaking strengths in two groups were increased remarkably on the 10th day after operation,and reached the peaks.but there were no significant differences of anastomic breaking strength at different time points between two groups(P>0.05).The hychoxyproline level of anastomosis:in experimental group was a little lower than that in control group at the 72tnd hour after operation,and both of them reached the peaks on the 7th day after operation;but there were no significant differences of hychoxyproline levels of anastomosis at different time points between two groups(P>0.05).Conclusion Early postoperative feeding can not cause the increase of anasmotic healing time and the incidence rate of gastrointestinal anastomotic fistula.