腹部手术闭合腹膜与未闭合腹膜二次探查研究

Two Simulation Studies on the Closed and Open Peritoneum in Abdomenal Operations

目的探讨腹部手术闭合腹膜与未闭合腹膜二次探查模拟研究。方法随机选取齐齐哈尔医学院动物室雌性家兔120只,随机分成4组(按手术后闭合腹膜与否、切口右侧是否腹膜造成缺损及腹膜有无出血灶而分组),每组各30例。第Ⅰ组:不缝合腹膜组,并给予切口右侧使腹膜造成缺损范围4cm×3cm;第Ⅱ组:不缝合腹膜组,并仍给予切口右侧使腹膜造成缺损范围4cm×3cm,在腹膜缺损区造成出血灶;第Ⅲ组:正常缝合腹膜组;第Ⅳ组:缝合腹膜且缝合得密集且紧。分析术后腹膜表面愈合情况。结果肉眼观察切口感染情况:Ⅰ组、Ⅲ组、Ⅳ组各1例;腹腔粘连情况,各组间相比粘连的发生率有显著差异:Ⅰ与Ⅱ组(P<0.01)、Ⅰ与Ⅲ组(P<0.01)、Ⅰ与Ⅳ组(P<0.01)、Ⅲ与Ⅳ组(P<0.01)。显微镜下见:Ⅰ、Ⅱ、Ⅲ、Ⅳ组术后相比,间皮细胞覆盖程度、肉芽组织、瘢痕组织、巨噬细胞反应程度及间皮下基膜厚度均有明显增多趋势。结论腹部手术闭合腹膜与未闭合腹膜二次探查模拟研究表明:腹部手术未闭合腹膜可减少粘连,不增加切口感染机会。

Objective To discuss two simulation studies on the closed and open peritoneum in abdomenal operations. Methods We selected 120 domestic female rabbits from animal laboratory of Qi Qi Ha＇ er Medical College at random and divided them into four groups （ according to whether the peritoneum was open or not, the degree of peritoneum defect at the right side of incision and the exist- ence of peritoneum hemorrhagic focus ） ,with 30 cases in each group. Group Ⅰ ： no peritoneum suture and making a defect of 4cm × 3cm at the right side of the incision; Group Ⅱ ： no peritoneum suture and making a defect of 4cm × 3cm at the right side of the incision,with a hemorrhagic focus at peritoneum defect;Group Ⅲ： with peritoneum suture; Group Ⅳ：with dense and compact peritoneum suture. And then we analyzed postoperative peritoneum healing progress. Results Observeations of the incision infection by the naked eye were that one case was identified in group Ⅰ , Ⅲ and Ⅳ ;and a significant difference of occurrence rate was identified between the fallowing groups ： group Ⅰ and Ⅱ （ P 〈 0. 01 ） , Ⅰ and Ⅲ （ P 〈 0.01 ） , Ⅰ and Ⅳ （ P 〈 0. 01 ） ,Ⅲ and Ⅳ （ P 〈 0.01 ）. Observations under microscope were that while making postoperative comparison, an obvious increasing trend of mesothelial cell coverage, granulation tissue, cicatricial tissue, macrophage reaction and mesothelial basal membrane thickness. Conclusion Openperitoneum can reduce accretio and chances of infection of incisional wound.