胰空肠端侧吻合术生物力学及病理学研究

TO INVESTIGATE IN VITODYNAMICS AND PATHOLOGY AFTER TIGHT STICKING PANCREATICOJEJUNOSTOMY

目的观察两种胰肠吻合方法在生物力学及病理学方面基础数据的比较。方法按吻合方法不同将动物分为紧贴式胰空肠吻合组(A组)和套入式胰肠端端吻合组(B组),术后每天肠内生理压力测定(第1～10天)、在此基础上人工高压(上述肠腔内每天平均生理压力的第2、3、4倍)检测吻合口情况及第十天活体测定破裂压和离断力并做病理观察。结果(1)每天术后生理压力:两种术式的压力曲线图基本相同。(2)每天人工高压检测吻合口:A组吻合口漏0/6例,d1-10,P2-4倍;B组吻合口漏2/6例,分别出现于d3,P2倍;d5,P2倍。(3)术后第十天破裂压、离断力测定:破裂压A组为282.17±24.41mmHg,B组为144±15.57 mmHg,两组之间差异有统计学意义(t=9.95,P<0.05);离断力A组为9.45±0.45 N,B组为6.9±0.32 N,两组之间差异有统计学意义(t=9.81,P<0.05)。(4)组织病理学:A组吻合口已由结缔组织基本修复,空肠浆膜层与胰腺包膜已愈合贴附。B组则由肉芽组织不完全修复,胰腺残端断面尚无上皮再生。结论紧贴式胰空肠吻合组(A组)更能抗肠腔内的扩张力、肠管拉力,吻合口愈合更快、更安全。

Objective To evaluate substructural dataes after types of pancreaticojejunostomy in vitodynamics and Pathology.Methods After resection of the pancreatic head,24 domestic dogs were divided into two groups according to the types of anastomosis：group A：tight sticking pancreaticojejunostomy;group B： end-to-end pancreaticojejunal invagination.（1）We measue enteric cavity,s physio-pressure after operation from 1to 10.（2）We detect Stomas with artificial high pressure by double、triple and quadruple above-mentioned average pressure.（3）We assess anastomotic strength invivo and histopathological findings on postoperative day 10.Results（1）The A group is the same as the B in enteric cavity,s physio-pressure after operation from 1to 10 from the curve chart.（2）The group A had noone Pancreatic fistula postoperative day from 1 to 10 by double、triple and quadruple pressure;but the B had 2 dogs which appeared in double pressure postoperative day 3 and day 5.（3）Bursting pressure was 282.17±24.41 mmHg in A group on day 10 after anastomosis,whereas 144±15.57 mmHg in group B.A significant difference was observed between group A and group B（t=9.95,P〈0.05）;Breaking strength was 9.45±0.45 N and 6.9±0.32 N in group B on day 10 after anastomosis.A significant difference was found between the two types of anastomosis（t=9.81,P〈0.05）.（4）Anastomotic site was well repaired by connective tissue and jejunal placenta percreta healed together with pancreatic peplos tightly.but the cut surface was incompletely repaired by granulation tissue and no regeneration of the epithelium was found in group B.Conclusion Anastomotic strengh of tight sticking pancreaticojejunostomy was stronger than end-to-end pancreaticojejunal invagination and the healing was more safer and rapid.