三种不同胰肠吻合术可靠性比较的实验研究

Comparison of wound healing after pancreaticojejunostomy with three anastomotic methods in piglets

目的观察3种不同胰肠吻合术的愈合过程,比较其吻合口的可靠性。方法按吻合术式的不同,将54只实验家猪分为3组：套入式胰肠端端吻合组(套入组)、捆绑式胰肠吻合组(捆绑组)和“墨池”式胰肠吻合组(“墨池”组),分别于术中、术后5 d、术后10 d测定吻合口爆破压和离断力,吻合口周围组织做病理检查。结果(1)爆破压：套入组术中、术后5 d、术后10 d分别为(67±8)、(96±11)、(131±9)mm Hg(1 mm Hg=0．133 kPa)；捆绑组分别为(140±8)、(179±10)、(269±13)mm Hg；“墨池”组分别为(102±10)、(171±18)、(254±24)mm Hg。捆绑组和“墨池”组较套人组在术中及术后5、10 d的爆破压均有明显增加(P<0．01)；捆绑组较“墨池”组术中爆破压高(P<0．05),但在术后5、10 d捆绑组爆破压与“墨池”组比较差异无统计学意义。(2)离断力：套入组术中及术后5、10 d分别为(4．6±0．6)、(5．8±0．5)、(7．1±0．6)N；捆绑组分别为(4．5±0．4)、(6．6±0．4)、(10．0±0．6)N；“墨池”组分别为(4．6±0．3)、(6．5±0．4)、(9．1±0．9)N；3组两两比较术中离断力基本相同；术后5、10 d时捆绑组和“墨池”组基本相同,均明显高于套入组(P<0．01)。(3)组织病理学：捆绑、“墨池”组在术后10 d时吻合口均已基本由结缔组织修复,胰腺残端断面已基本由黏膜上皮覆盖。而套入组则由肉芽组织不完全修复,胰腺残端断面尚无上皮再生。结论捆绑式胰肠吻合口愈合强度高、速度快。“墨池”式胰肠吻合口愈合速度也较快,但抗离断力方面不如捆绑式。套入式吻合口可靠性在3种胰肠吻合术式中最差,具有较大的胰漏风险。

Objective To evaluate wound healing after pancreaticojejunostomy of three anastomotic methods. Methods Fifty-four domestic piglets were divided into three groups according to the types of anastomoses： group of end-to-end pancreaticojejunal invagination （EE group）, group of binding pancreaticojejunostomy （BP group） and group of inkwell pancreaticojejunostomy （IP group ）. Bursting pressure, breaking strength and histopathological findings of anastomosis were assessed on operative day and on the 5th and 10th day after operation. Results Bursting pressure was （67 ± 8 ） mm Hg, （96 ± 11 ） mm Hg and （131±9） mm Hg in EE group on day 0, 5 and 10; and （140±8） mmHg, （179±10） mmHg and （269 ±13） mm Hg in BP group; and （ 102 ± 10） mm Hg, （ 171 ± 18） mm Hg and （254 ±24） mm Hg in IP group. Compare to EE group, bursting pressure of BP group and IP group were all increased with significant differences（P 〈 0. 05）. Another significant difference was observed between BP group and IP group after anastomoses on operative day. Breaking strength was （ 4. 6 ± 0. 6） N, （5.8 ±0. 5 ） N and （7.1 ±0. 6） N in EE group on 0 d, 5 d and 10 d; and （4. 5 ±0.4） N,（6. 6±0.4） N and （10.0 ±0. 6） N in BPgroup; and （4.6 ±0.3）N,（6.5 ±0.4）N and （9.1 ±0.9）N in IP group. A similar value of anastomoses was shown in BP group and IP group on day 0, day 5 and day 10, but significant increase was demonstrated compared to EE group on day 5 and 10. Anastomotic site was well repaired by connective tissue and the cut surface of pancreatic stump was covered by mucosal epithelium in BP group and IP group on day 10, but the cut surface was incompletely repaired by granulation tissue and no regeneration of the epithelium was found in EE group. Conclusions Wound healing of binding pancreaticojejunostomy and inkwell pancreaticojejunostomy is more rapid and better than end-to-end pancreaticojejunal invagination, but breaking strength of inkwell pancreaticojejunostomy is weaker than binding pancreaticojejunostomy.