二种胰肠吻合术吻合口创伤愈合的实验研究

Wound healing after pancreaticojejunostomy in piglets:a comparison between two anastomotic methods

目的 观察比较两种胰肠吻合方法创伤愈合过程。 方法 按吻合方法不同将动物分为捆绑式胰肠吻合组 (Ⅰ组 )和套入式胰肠端端吻合组 (Ⅱ组 ) ,分别在术中、术后 5、10d活体测定吻合口破裂压和离断力 ,并做病理观察。 结果 (1)破裂压 :Ⅰ组 ,0、5、10d分别为 (139 7± 8 0 )mmHg、(178 7± 9 7)mmHg和 (2 6 8 8± 12 8)mmHg ,Ⅱ组则为 (6 7 3± 7 9)mmHg、(96 2± 10 4 )mmHg和 (130 6± 9 3)mmHg。Ⅰ组和Ⅱ组在 0至 5d和 5至 10d两时间段分别增加 2 7 9%、5 0 5 %和 4 2 9%、35 7% ,两组间在 0、5、10d时差异具有非常显著性 (P <0 0 1)。 (2 )离断力 :Ⅰ组 ,0、5、10d分别为 (4 5± 0 4 )N、(6 6± 0 4 )N和 (10 0± 0 6 )N ;Ⅱ组为 (4 6± 0 6 )N、(5 8± 0 5 )和 (7 1± 0 6 )N。两组在 0天时基本相同 ,但Ⅰ组在 0至 5d和 5至 10d两时间段有较快增长(44 8%和 5 2 9% ) ,两组间在 5、10d时差异具有显著和非常显著性 (P <0 0 5和P <0 0 1)。 (3)组织病理学 :Ⅰ组在 10d时吻合口已由结缔组织基本修复 ,胰腺残端断面已基本由黏膜上皮覆盖。而Ⅱ组则由肉芽组织不完全修复 ,胰腺残端断面尚无上皮再生。 结论 捆绑组 (Ⅰ组 )吻合口强度更强 ,愈合更快。

ObjectiveTo evaluate wound healing after types of pancreaticojejunostomy.Methods After resection of the pancreatic head, 38 domestic piglets were divided into two groups according to the types of anostomoses:group Ⅰ: binding pancreaticojejunostomy, a new technique designed and advocated by professor Peng Shuyou;groupⅡ: end-to-end pancreaticojejunal invagination. Anastomotic strength in vivo and histopathological findings were assessed on operative day and postoperative day 5 and 10.Results Bursting pressure was 139.7±8.0,178.7±9.7 and 268.8±12.8 mm Hg in group Ⅰ on day 0, 5 and 10, whereas 67.3±7.9, 96.2±10.4 and 130.6±9.3 mm Hg in group Ⅱ. The gain on day 0 to 5 and 5 to 10 was 27.9% and 50.5% in groupⅠ and 42.9% and 35.7% in group Ⅱ, respectively. A significant difference was observed between group Ⅰ and group Ⅱ, and between 5 and 10 day after anastomoses ( P < 0.01).Breaking strength was 4.5±0.4,6.6±0.4 and 10.0±0.6 N in groupⅠ on day 0, 5 and 10 and 4.6±0.6,5.8±0.5 and 7.1±0.6 N in group Ⅱ. Although a similar value was shown in both types of anastmoses on day 0, a rapider gain was demonstrated on day 0 to 5 and 5 to 10 in groupⅠ(44.8% and 52.9%)than in groupⅡ(25.4% and 22.0%). A significant difference was found on day 5 and 10 between the two types of anastomoses ( P < 0.05 and P < 0.01). Anastomotic site was well repaired by connective tissue and the cut surface of pancreatic stump was covered by mucosal epithelium in group Ⅰ on day 10, but the cut surface was incompletely repaired by granulation tissue and no, regeneration of the epithelium was found in groupⅡ.ConclusionAnastomotic strengh of binding pancreaticojejunostomy was stronger than end-to-end pancreaticojejunal invagination and the healing was better and rapid.