拖靠吻合法在膀胱肠管吻合中的动物实验研究

An animal research on the application of drag-and-bond anastomosis in the anastomosis between bladder and intestine

目的探讨拖靠吻合法在实验兔膀胱与肠管吻合中的可行性。方法采用40只日本大耳兔构建动物模型, 体重(3.30±0.32)kg。通过随机数字表法将日本大耳兔分为实验组和对照组, 每组各20只;实验组采用拖靠吻合法进行吻合, 即将膀胱颈固定至导尿管后往外牵引导尿管, 借助导尿管的牵引使膀胱颈与远端肠管吻合的免缝合方式;对照组采用膀胱与肠管常规间断缝合的方式进行吻合。比较两组手术时间、吻合时间、术中出血量、术后吻合口尿瘘率及术后吻合口组织愈合情况。结果实验组手术时间短于对照组[(33.26±2.79)min与(35.25±1.83)min], 差异有统计学意义(P=0.014);实验组吻合时间短于对照组[(7.55±1.24)min与(8.65±1.03)min], 差异有统计学意义(P=0.005)。实验组术中出血量与对照组差异无统计学意义[(6.47±2.41)ml与(6.75±1.83)ml, P=0.691]。术后实验组10例行膀胱造影者中2例出现造影剂外渗, 吻合口尿瘘率为20.0%(2/10);对照组9例行膀胱造影者中1例出现造影剂外渗, 吻合口尿瘘率为11.1%(1/9), 两组差异无统计学意义(P=0.348)。实验组吻合口组织愈合评分与对照组差异无统计学意义[(2.0±0.7)分与(2.1±0.7)分, P=0.767]。结论采用拖靠吻合法对膀胱与肠管吻合, 操作简单、吻合时间短, 为该方法在临床中应用提供动物实验基础。

Objective To explore the feasibility of anastomosis between bladder and intestine of experimental rabbit by drag anastomosis.Methods In this study 40 Japanese big-eared rabbits were randomly divided into two groups through random number table,the experimental group and the control group,each group with 20 rabbits.In the experimental group,the bladder neck was fixed to the catheter and then the catheter was drawn outward.With the traction of the catheter,the bladder neck was anastomosed with the distal intestinal tube by means of suture free.The control group was anastomosed by regular interrupted suture of bladder and intestine.The operation time,anastomosis time,intraoperative blood loss,postoperative urinary leakage rate and postoperative anastomotic healing of rabbits in the two groups were compared.Results The operation time of the experimental group was shorter than that of the traditional interrupted suture anastomosis group[(33.26±2.79)min vs.(35.25±1.83)min,P=0.014].The anastomosis time of the experimental group was significantly shorter than that of the traditional interrupted suture anastomosis group[(7.55±1.2)min vs.(8.65±1.03 min),P=0.005].The intraoperative blood loss in the experimental group was similar to that in the control group[(6.47±2.41)ml vs.(6.75±1.83)ml,P=0.691].The event of contrast media extravasation occurred in 2 of the 10 experimental rabbits after receiving cystography in the experimental group,and the urinary leakage rate was 20%(2/10).In the control group,contrast media extravasation occurred in 1 of the 9 experimental rabbits after receiving cystography,and the urinary leakage rate was 11.1%(1/9),and the difference of the two groups was not statistically significant(P=0.348).Anastomotic healing score was(2.0±0.7)in the experimental group,and(2.1±0.74)in the control group(P=0.767).Conclusions The bladder-intestine drag-and-bond anastomosis technique,with significantly shorter anastomosis time,was feasible,easy and convenient.Our research provides an experimental and theoretical basis for the clinical application of drag-and-bond anastomosis technique in clinic.