不同肠管吻合方式对吻合口愈合的影响

Comparison of single-layer anastomosis and double-layer anastomosis of small intestine in dogs

目的观察不同吻合方法对犬小肠手术后吻合口愈合的影响，探讨其有效性及安全性。方法成年犬12条，根据吻合部位不同随机分为A、B2组，A组距离屈式韧带100cm小肠采用双层吻合，距离屈式韧带200cm小肠采用单层吻合；B组反之。术中记录2种吻合方式的操作时间。术后7d再次手术，找到吻合口并评价吻合口周围粘连分级，测量吻合破裂压（ABP）、小肠浆肌层破裂压。结果单层吻合与双层吻合后局部粘连分级未见明显差异；单层吻合与双层吻合的ABP分别为（325．83±88．03）和（331．25±70．33）cmH2O（1emH2O=0．098kPa，P〉0．05）；单层吻合与双层吻合的浆肌层破裂压分别为（185．42±40．87）和（182．08±20．72）emH，O（P〉0．05）；单层吻合和双层吻合时问分别为（17．08±3．20）和（23．50土2．50）min（P〈0．01）。结论单层吻合法是一种安全、有效的小肠吻合方法。

Objective To evaluate the effectiveness and safety of single-layer anastomosis and double-layer anastomosis of small intestine. Methods Twelve dogs were divided into two groups ： group A （single-layer anastomosis at small intestine 100 cm after Treitz ligament and double-layer anastomosis at small intestine 200 cm after Treitz ligament, n = 6） ; group B （double-layer anastomosis at small intestine 100 cm after Treitz ligament and single-layer anastomosis at small intestine 200 cm after Treitz ligament, n = 6）. The time used for each anastomosis were recorded. The second operations were performed on post-operative day 7 on all the dogs to determine in situ anastomostic bursting pressures （ABP） and the pressures while the serosa layer was torn. Results No anastomosis leak was found in twenty-four stoma of the twelve dogs. There was no significant difference between the stoma created by single-layer anastomosis and double-layer anastomosis on intraperitoneal adhesions. The averaged ABP in the single-layer anastomosis group and the double-layer anastomosis group was （325.83±88.03 ） and （331.25±70. 33 ） cm H20 （1 cm H2O±0. 098 kPa, P 〉0. 05）. The pressures while the serosa layer was torn in the two group was （ 185.42±40. 87） and （ 182.08±20. 72） cm H20 respectively （P 〉0.05）. The time used for single-layer anastomosis and double-layer anastomosis was （ 17.08±3.20） and （23.50±2. 50） minutes respectively （P 〈 0. 01 ）. Conclusion The single-layer anastomosis is an effective and safe method for the anasto-mosis of small intestine.