贯穿式间断胰肠吻合的动物实验研究

Animal study of interrupted running-through suture pancreaticojejunostomy

目的:通过动物实验探讨贯穿式间断胰肠吻合的可行性和安全性,为临床应用提供实验依据。方法:将20头实验猪随机均分为实验组与对照组,分别采用贯穿式间断胰肠吻合和胰腺空肠导管对黏膜吻合建立胰肠吻合模型。记录两组胰肠吻合时间,术后3d引流管淀粉酶含量,并于术后1周取出吻合口,行病理学检测及平滑肌肌动蛋白(SMA)的免疫组化检测。结果:实验组中胰肠吻合时间与对照组比较明显减少[(14.0±3.6)minvs.(20.9±3.2)min,P<0.05];尽管两组术后总胰瘘发生率差异无统计学意义(11.1%vs.40.0%,P>0.05),但实验组仅1例A级胰瘘,而对照组B、C级胰瘘各2例;病理学检测结果显示,实验组较对照组吻合口炎症明显减轻、肠壁与胰腺组织贴合更为紧密,且SMA免疫组化染色阳性率明显高于对照组(88.9%vs.20%,P<0.05)。结论:相对于传统的胰腺空肠导管对黏膜吻合,贯穿式间断胰肠吻合操作较为简单、吻合时间短、固定可靠、术后胰瘘发生率较低,值得临床应用。

Objective:To assess the feasibility and safety of the interrupted running-through suture pancreaticojejunostomy though an animal experiment,for providing an experimental basis for clinical application.Methods:Twenty experimental pigs were equally randomized into study group and control group,and then underwent interrupted running-through suture or pancreatic duct-to-jejunal mucosa anastomosis to establish the pancreaticojejunostomy models.In the two groups,the time for pancreaticojejunostomy and the amylase level in the drainage tube on postoperative day 3 were recorded,and the anastomotic stomas were cut off one week after operation for pathological examination and immunohistochemical staining of smooth muscle actin (SMA).Results:The time to perform pancreaticojejunostomy was significantly reduced in study group compared with control group [(14.0±3.6) min vs.(20.9±3.2) min,P<0.05].Although there was no statistical significance in the overall incidence of postoperative pancreatic fistula between the two groups (11.1% vs.40.0%,P>0.05),only one case of grade A pancreatic fistula was noted in study group,while 2 cases each of grade B and C pancreatic fistula occurred in control group.The results of pathological examination showed that the inflammation in the anastomotic stoma was milder and the attachment of the jejunal wall to the pancreatic stump was tighter in study group than those in control group,and the positive rate of SMA immunohistochemical staining was significantly higher in study group than that in control group (88.9% vs.20%,P<0.05).Conclusion:Compared to the traditional pancreatic duct-to-jejunal mucosa anastomosis,the interrupted running-through suture pancreaticojejunostomy has the advantages of being easy to perform,reduced anastomosis time,reliable fixation,and decreased incidence of pancreatic fistula.So,it is recommended to be used in clinical practice.