兔食管胃吻合口残端血供对食管胃吻合口术后愈合的影响

目的 探讨兔食管胃吻合口残端血供与其愈合的相关关系。方法 将27只新西兰大白兔随机分为正常对照组(Ⅰ组)、食管血供减少组(Ⅱ组)和胃血供减少组(Ⅲ组),均经腹行食管胃一次全层间断吻合。其中Ⅱ组游离食管50~60 mm、Ⅲ组结扎胃左动脉等血管,术后10 d处死实验兔行吻合口大体解剖观察、测定食管胃吻合口抗张强度、取吻合口组织行羟脯氨酸测定及病理切片检查。结果 Ⅰ组出现吻合口瘘1例、Ⅲ组出现胃底坏死穿孔1例,其余实验兔病理切片均提示食管胃吻合口组织已愈合。Ⅲ组吻合口羟脯氨酸含量、抗张强度与Ⅰ组、Ⅱ组相比均降低(P<0.05), 但Ⅱ组与Ⅰ组相比无统计学差异(P>0.05)。结论 兔胃残端血供相对减少使吻合口组织抗张强度下降,可能减弱了吻合口早期牢固程度,但吻合口组织已初步愈合且吻合口瘘的发生并无增加,提示娴熟的手术技术是吻合口组织愈合的主要保证。

Influence of blood supply of the esophageal and gastric stumps on anastomotic healing after esophagogastrostomy in rabbits

Objective To study how blood supply of the esophageal and gastric stumps influences the anastomotic healing after esophagogastrostomy in rabbits. Methods Twenty-seven New Zealand rabbits were randomly divided into 3 groups to receive esophagogastrostomy, followed by different procedures. Except for those in groupⅠ, all the rabbits were subjected to procedures of reducing the blood supply either of the esophageal or the gastric stump (group Ⅱ and group Ⅲ, respectively), followed by single-layer esophagogastric anastomoses using interrupted 5-0 polypropylene sutures. Ten days after operation, all the rats were killed and the anastomotic sites excised for measurement of the inner diameter, tensile strength, and hydroxyproline concentration. Results Healing of the esophagograstric anastomosis was obtained in all the rabbits but one with anastomotic leakage in groupⅠand one with perforation of the gastric fundus in groupⅢ. The anastomotic inner diameters were similar in all the three groups, whereas the tensile strength and hydroxyproline concentration at the anastomoses decreased in group Ⅲ in comparison with the other two groups (P<0.05) that had similar measurements (P>0.05). Conclusions Extended length of the free esophageal stump does not significantly affect anastomotic healing as decrease of blood supply in the gastric stump.