2种肠管吻合手术的术后愈合及黏连情况比较

Comparison of postoperative healing and adhesion for two kinds of intestinal anastomosis

课题组前期研制出一种新型携带多种药物成分的内支撑物,并将其应用于试验犬的肠管吻合术中,此研究表明采用内支撑物应用于犬肠管吻合术,与传统吻合术比较,可降低手术操作的难度,缩短吻合时间,且术后无明显并发症,愈合良好。为了进一步探讨这种新吻合技术的可行性及相关机制,课题组从腹腔黏连评分、吻合口爆破压和羟脯氨酸含量等方面对2组犬的术后愈合情况进行比较研究。以健康本地犬为试验动物,分为内置支撑物组(NZ组,12只)和传统手术组(CS组,12只),分别在术后3,7,14,28d,剖腹探查,观察吻合部位愈合情况,进行腹腔黏连评分,并对吻合口爆破压、吻合口组织中羟脯氨酸含量等项目进行检测。腹腔黏连结果表明术后7,14,28d,CS组的腹腔黏连评分显著高于NZ组,结果具有统计学意义(P<0.05),术后3d,CS组的腹腔黏连评分与NZ组相比无显著性差异(P>0.05);术后7,14d,CS组的吻合口爆破压显著低于NZ组(P<0.05),而在术后3,28d,2组吻合口爆破压相比无显著性差异(P>0.05);2组的羟脯氨酸含量均随时间的增长而增加,而在各个时间点上2组相比无显著性差异(P>0.05)。最终试验结果表明,相对传统小动物肠管吻合术而言,使用内支撑物进行该手术能减少术后黏连,吻合部位的愈合情况更为良好。

In the previous study,a new type of stent carrying many kinds drugs was developed and was applied to canine intestinal anastomosis of experimental dogs,it shows that the use of stent in canine intestinal anastomosis,compared with the traditional anastomosis, can reduce the difficulty of operation, shorten the anastomosis time and present good healing without obvious complica- tions. For further exploration of the feasibility and relevant mechanism of this new anastomosis technique,the study compared the postoperative healing of 2 groups of dogs from aspects of ab- dominal adhesion score, anastomotic burst pressure and hydroxyproline content. Twenty-four healthy local dogs were randomly divided into two groups, the conventional anastomosis group （CS group,n=12） and the stent anastomosis group （NZ group,n= 12）. Laparotomy detection,obser- vation of the healing of anastomotic site,scoring of the abdominal adhesion as well as detection of the bursting pressure and the hydroxyproline content in the anastomotic tissue were conducted at postoperative days 3, 7, 14, 28 d, respectively. Abdominal adhesion showed that there wasno difference between two groups in the early than NZ group in the middle stage （7 and 14 stage （3 d） （P〉0.05） ,but CS group seemed higher d） and the last stage （28 d） （P〈0.05）. The differ- ence of bursting pressure between two groups at the 3rd and 28th day was statistically significant （P〉0.05） ,while CS group seemed lower than NZ group at the 7th and 14th day （P〈0.05）. De- termination of hydroxyproline contents showed that hydroxyproline contents increased gradually over time but there was no significant difference compared with CS group at the same period （P〉0.05）. Final results showed that, compared to the traditional intestinal anastomosis of small ani- mals,using stent to carry out intestinal anastomosis can reduce postoperative adhesions and im- prove the healing of the anastomotic site.