不同肠管吻合方式对吻合口愈合的影响

目的 观察不同吻合方法对犬小肠手术后吻合口愈合的影响,探讨其有效性及安全性.方法 成年犬12条,根据吻合部位不同随机分为A、B2组,A组距离屈式韧带100 cm小肠采用双层吻合,距离屈式韧带200 cm小肠采用单层吻合；B组反之.术中记录2种吻合方式的操作时间.术后7d再次手术,找到吻合口并评价吻合口周围粘连分级,测量吻合破裂压(ABP)、小肠浆肌层破裂压.结果 单层吻合与双层吻合后局部粘连分级末见明显差异；单层吻合与双层吻合的ABP分别为(325.83±88.03)和(331.25±70.33) cmH2O(1 cm H2O=0.098 kPa,P＞0.05)；单层吻合与双层吻合的浆肌层破裂压分别为(185.42±40.87)和(182.08±20.72) cm H2O(P＞0.05)；单层吻合和双层吻合时间分别为(17.08±3.20)和(23.50±2.50) min(P ＜0.01).结论 单层吻合法是一种安全、有效的小肠吻合方法.

Comparison of single-layer anastomosis and double-layer anastomosis of small intestine in dogs

Objective To evaluate the effectiveness and safety of single-layer anastomosis and double-layer anastomosis of small intestine.Methods Twelve dogs were divided into two groups:group A ( single-layer anastomosis at small intestine 100 cm after Treitz ligament and double-layer anastomosis at small intestine 200 cm after Treitz ligament,n =6) ; group B (double-layer anastomosis at small intestine 100 cm after Treitz ligament and single-layer anastomosis at small intestine 200 cm after Treitz ligament,n =6).The time used for each anastomosis were recorded.The second operations were performed on postoperative day 7 on all the dogs to determine in situ anastomostic bursting pressures (ABP) and the pressures while the serosa layer was tom.Results No anastomosis leak was found in twenty-four stoma of the twelve dogs.There was no significant difference between the stoma created by single-layer anastomosis and double-layer anastomosis on intraperitoneal adhesions.The averaged ABP in the single-layer anastomosis group and the double-layer anastomosis group was (325.83 ± 88.03) and (331.25 ± 70.33) cm H2O ( 1 cm H2O =0.098 kPa,P ＞ 0.05 ).The pressures while the serosa layer was torn in the two group was ( 185.42 ± 40.87 ) and ( 182.08 ± 20.72) cm H2O respectively ( P ＞ 0.05 ).The time used for single-layer anastomosis and double-layer anastomosis was ( 17.08 ± 3.20 ) and (23.50 ± 2.50 ) minutes respectively (P＜0.01 ).Conclusion The single-layer anastomosis is an effective and safe method for the anastomosis of small intestine.