食管胃黏膜延长分层吻合的实验研究

目的　探讨食管胃吻合抗胃食管反流、预防吻合口瘘及狭窄的术式。　方法　选杂种犬 5 8条 ,随机分为实验组和对照组。实验组 :31条犬 ,自贲门横断 ,食管黏膜延长 1.5～ 2 cm;切除部分胃小弯 ,剥除大弯侧保留部分浆肌层 ,成形为宽 3～ 3.5 cm、长 4～ 5 cm黏膜管 ,行食管胃黏膜、肌层分层吻合。对照组 :2 7条犬 ,用“深套叠”术式。于术后 3～ 180天检测对比分析。　结果　两组突入胃内结构长度、肌层吻合口直径差别无显著性意义 (P>0 .0 5 ) ,黏膜游离缘直径差别有显著性意义 (P<0 .0 1) ;实验组能耐受较高胃内压 ,胃与食管压力差两组差别有显著性意义 (P<0 .0 1) ;突向胃腔内结构厚度两组相差 1倍以上 ;实验组成形黏膜血供良好 ,吻合口愈合及缝线脱落早于对照组。　结论　适当剥除肌层不引起黏膜缺血坏死 ;成形黏膜瓣薄软 ,具有良好的抗反流效果 ;黏膜层密缝对合严密、愈合快 ,能有效预防吻合口瘘的发生 ,不同平面吻合狭窄发生率低。

Experimental Research for the Prolongation-delamination Anastomosis of the Esophagogastric Mucous Membrane

Objective To explore the esophagogastric anti-reflux of the esophagogastrostomy, in preventing the leakage and stricture of the anastomotic stoma formation. Methods Fifty-eight mongrel dogs as the experimental objects were randomly divided into the experiment group(31 dogs) and the control group (27 dogs). Experimental group: esophagus was transected at cardia with its mucous membrane lengthened by 1.5-2.0 cm. Some of lesser curvature of stomach was resected and seromuscular layer was conserved by stripping greater curvature of the stomach. Then remnant of the seromuscular layers of stomach was shaped into a mucous membrane tube with 3-3.5cm wide and 4-5cm long.Esophagogastric mucous membrane and seromuscular were separately anastomosed layer by layer. Control group: the operation of 'deep intussusception' was performed. The dogs were killed in 3-180 days after the operation and data were analysed. Results The length of the protrusion into the gastric cavity and the diameter of the anastomotic stoma of the muscular membrane had no significantly difference in two groups ( P> 0.05). The diameter of the free eage of the mucous membrane were obviously different in two groups ( P< 0.01). The dogs in the experimental group could bear higher gastric pressure and the disparity in pressure between stomach and esophagus was significant in two groups ( P< 0.01). The thickness of the protrusion structure into the gastric cavity was different in two groups, with a difference of more than one time in thickness in two groups. The blood supply of the mucous membrane in the experimental group was good, and the healing of anastomosed stoma and falling out of suture were earlier than that in the control group. Conclusion To strip the muscular membrane properly does not result in ischemia necrosis of the mucous membrane. Because the valve of the mucous membrane shaped is thin and soft, it has the better effects on anti-reflux . Mucous membrane layers have the tight para-position and are healed quickly, which can prevent occurance of the fistula of the anastomotic stoma effectively. There is little incident of the stricture of the anastomotic stoma in different planes.