镍钛记忆合金加压吻合夹在胃肠吻合中的应用

Application of nickel titanium compression anastomosis clip in gastrointestinal anastomosis

目的评价镍钛记忆合金加压吻合夹（CAC）在胃肠吻合中的有效性及安全性。方法回顾性分析2007年1月至2011年12月福建医科大学附属第一医院应用CAC或管状金属钉式吻合器行胃肠吻合的413例患者的临床资料。根据术中使用吻合器的不同分为CAC组（227例）和管状金属钉式吻合器组（186例）。比较两组患者胃肠吻合时间、术中吻合口出血情况、术后与吻合相关的并发症发生情况、手术切口情况、术后肛门排气时间以及CAC的排出时间。计量资料采用t检验，计数资料采用，检验。结果CAC组胃肠吻合时间为（8．3±2．5）min，短于管状金属钉式吻合器组的（18．7±3．6）min，两组比较，差异有统计学意义（t=5．74，P〈0．05）。CAC组和管状金属钉式吻合器组患者术后平均肛门排气时间、住院时间、住院费用比较，差异无统计学意义（t=0．27，1．32，3．11，P〉0．05）。CAC组患者均无术中吻合口出血，而管状金属钉式吻合器组患者术中吻合口出血发生率为3．23％（6／186），两组比较，差异有统计学意义（χ2=7．43，P〈0．05）。CAC组患者术后胃排空障碍发生率为0．88％（2／227），与管状金属钉式吻合器组的1．08％（2／186）比较，差异无统计学意义（χ2=0．04，P〉0．05）。CAC组与管状金属钉式吻合器组患者术后吻合口狭窄、吻合口炎发生率分别为0（0／227）、11．01％（25／227）和2．15％（4／186）、21．50％（40／186），两组比较，差异有统计学意义（χ2=4．93，8．49，P〈0．05）。两组患者术后均无吻合口瘘发生。CAC组患者的吻合夹均于术后12—26d排出体外。结论应用CAC完成胃肠吻合，是一种安全、有效、可行的方法。

Objective To investigate the efficacy and safety of nickel titanium compression anastomosis clip （CAC） in gastrointestinal anastomosis. Methods The clinical data of 413 patients who received gastrointes- tinal anastomosis with nickel titanium CAC or curved stapler at the First Affiliated Hospital of Fujian Medical University from January 2007 to December 2011 were retrospectively analyzed. All the patients were divided into the CAC group （227 patients） and the curved stapler group （186 patients）. The time for gastrointestinal anasto- mosis, anastomotic bleeding, complications, condition of the incision sites, the first postoperative flatus and time for the excretion of the CAC between the 2 groups were compared. All data were analyzed using the t test or chi- square test. Results The time for gastrointestinal anastomosis of the CAC group was （ 8.3± 2.5 ） minutes, which was significantly shorter than （ 18.7 ± 3.6） minutes of the curved stapler group （ t = 5.74, P 〈 0.05 ）. There were no significant difference in the time of postoperative flatus, duration of hospital stay and costs between the 2 groups （ t = 0. 27, 1.32, 3.11, P 〉 0.05 ）. No patients in the CAC group had anastomotic bleeding, while the incidence of anastomotic bleeding of the curved stapler group was 3.23% （6/186） , with a significant difference between the 2 groups （χ2 = 7.43, P 〈 0.05 ）. The incidences of gastric emptying dysfunction of the CAC group and the curved stapler group were 0.88% （2/227） and 1.08% （2/186）, with no significant difference between the 2 groups （χ2= 0. 04, P 〉 0.05 ）. The incidences of postoperative anastomotic stricture and anastomositis were 0 （0/227） and 11.01% （25/227） in the CAC group, and 2.15% （4/186） and 21.50% （40/186） in the curved stapler group, with significant differences between the 2 groups （χ2 = 4. 93, 8.49, P 〈 0.05）. No anastomotic fistula was detected in the 2 groups. The CAC was excreted at postoperative day 12-26. Conclusion CAC is safe and effective for gastrointestinal anastomosis.