消化道重建三种吻合方法的微循环研究

Microcirculatory Study on Three Kinds of Anastomoses for Digestive Tract Reconstruction

目的比较研究常用的三种肠吻合术的吻合口微循环及愈合情况。方法杂种犬18只,每只犬小肠的近端、中段及远端分别进行A lbert单层吻合、A lbert-Lembert双层吻合及吻合器吻合,每种吻合均有6只犬在相同部位进行同一种吻合。分别于术后3、5、7 d行二次开腹手术,对比观察吻合口的微循环、愈合情况、病理形态学、肠组织匀浆的SOD活性和MDA含量。结果单层吻合与吻合器吻合术后,吻合口区域的微区血流量、微循环流态、微血管的面密度和数密度均优于双层吻合术,且前两者的过氧化损伤、炎症反应和吻合口内翻较轻,手术用时较短。结论肠单层吻合与吻合器吻合术后,吻合口的微循环重建和愈合情况优于双层吻合术。

Objective To compare microcirculation of anastomotic stoma and wound healing condition among three kinds of intestinal anastomoses. Methods 18 hybrid dogs all underwent Albert single-layer anastomosis, Albert-Lembert double-layer anastomosis and stapler anastomosis at proximal end, midpiece and distal end of small intestine. 6 dogs underwent same anastomosis at same location. Second abdominal operation was performed respectively at day 3, 5,7 after anastomosis. Before operation and day 3, 5, 7, after operation, microcirculation and wound healing were observed, changes of pathological morphology were examined, levels of SOD and MDA in tissue homogenates of anastomotic stoma were measured. Results After anastomoses of single-layer and stapler, the volume of regional blood flow and the microcirculatory flow conditon, and the densities of area and amount of micrangium at anastomotic stoma were all better than those of double-layer group. In first two groups, the damage of peroxidation, the inflammatory response and inversion of anastomotic stoma were slightest. Operative time of single group and stapler group was significandy shorter than that of double group. Conclusion The micrangium reconstruction and healing of anastomotic stoma in single-layer and stapler of intestinal anastomoses were better than those of double-layer anatomosis.