二种胰肠吻合术吻合口创伤愈合的实验研究

目的　观察比较两种胰肠吻合方法创伤愈合过程。　方法　按吻合方法不同将动物分为捆绑式胰肠吻合组 (Ⅰ组 )和套入式胰肠端端吻合组 (Ⅱ组 ) ,分别在术中、术后 5、10d活体测定吻合口破裂压和离断力 ,并做病理观察。　结果　 (1)破裂压 :Ⅰ组 ,0、5、10d分别为 (139 7± 8 0 )mmHg、(178 7± 9 7)mmHg和 (2 6 8 8± 12 8)mmHg ,Ⅱ组则为 (6 7 3± 7 9)mmHg、(96 2± 10 4 )mmHg和 (130 6± 9 3)mmHg。Ⅰ组和Ⅱ组在 0至 5d和 5至 10d两时间段分别增加 2 7 9%、5 0 5 %和 4 2 9%、35 7% ,两组间在 0、5、10d时差异具有非常显著性 (P <0 0 1)。 (2 )离断力 :Ⅰ组 ,0、5、10d分别为 (4 5± 0 4 )N、(6 6± 0 4 )N和 (10 0± 0 6 )N ;Ⅱ组为 (4 6± 0 6 )N、(5 8± 0 5 )和 (7 1± 0 6 )N。两组在 0天时基本相同 ,但Ⅰ组在 0至 5d和 5至 10d两时间段有较快增长(44 8%和 5 2 9% ) ,两组间在 5、10d时差异具有显著和非常显著性 (P <0 0 5和P <0 0 1)。 (3)组织病理学 :Ⅰ组在 10d时吻合口已由结缔组织基本修复 ,胰腺残端断面已基本由黏膜上皮覆盖。而Ⅱ组则由肉芽组织不完全修复 ,胰腺残端断面尚无上皮再生。　结论　捆绑组 (Ⅰ组 )吻合口强度更强 ,愈合更快。

Wound healing after pancreaticojejunostomy in piglets: a comparison between two anastomotic methods

OBJECTIVE: To evaluate wound healing after types of pancreaticojejunostomy. METHODS: After resection of the pancreatic head, 38 domestic piglets were divided into two groups according to the types of anastomoses: group I: binding pancreaticojejunostomy, a new technique designed and advocated by professor Peng Shuyou; group II: end-to-end pancreaticojejunal invagination. Anastomotic strength in vivo and histopathological findings were assessed on operative day and postoperative day 5 and 10. RESULTS: Bursting pressure was 139.7 +/- 8.0, 178.7 +/- 9.7 and 268.8 +/- 12.8 mm Hg in group I on day 0, 5 and 10, whereas 67.3 +/- 7.9, 96.2 +/- 10.4 and 130.6 +/- 9.3 mm Hg in group II. The gain on day 0 to 5 and 5 to 10 was 27.9% and 50.5% in group I and 42.9% and 35.7% in group II, respectively. A significant difference was observed between group I and group II, and between 5 and 10 day after anastomoses (P < 0.01). Breaking strength was 4.5 +/- 0.4, 6.6 +/- 0.4 and 10.0 +/- 0.6 N in group I on day 0, 5 and 10 and 4.6 +/- 0.6, 5.8 +/- 0.5 and 7.1 +/- 0.6 N in group II. Although a similar value was shown in both types of anastomoses on day 0, a rapider gain was demonstrated on day 0 to 5 and 5 to 10 in group I (44.8% and 52.9%) than in group II (25.4% and 22.0%). A significant difference was found on day 5 and 10 between the two types of anastomoses (P < 0.05 and P < 0.01). Anastomotic site was well repaired by connective tissue and the cut surface of pancreatic stump was covered by mucosal epithelium in group I on day 10, but the cut surface was incompletely repaired by granulation tissue and no, regeneration of the epithelium was found in group II. CONCLUSION: Anastomotic strength of binding pancreaticojejunostomy was stronger than end-to-end pancreaticojejunal invagination and the healing was better and rapid.