舰艇航行中枪弹及锐器致犬腹部伤的肠吻合手术探讨

An exploration of intestinal anatomosis operated on dogs with gunshots and sharp instruments injuries during deployment at sea

目的 :通过观察 ,分析航行中枪弹及锐器致犬腹部伤肠吻合手术后术犬生存情况 ,探讨海战情况下腹部肠管创伤的最佳手术方式 ,提高航行条件下肠吻合手术的操作技能。方法 :选取杂犬 36只 ,实施枪弹致伤 2 2只 ,锐器致伤 14只 (2组包括再次手术犬各 9只 ) ,航行条件下随机分组 ,紧急行肠管一层和二层吻合术 ,观察术犬手术后生存情况。结果 :①一层吻合术 18只犬术后仅 2只吻合口轻度狭窄但无明显梗阻 ,无吻合口漏或出血发生。二层吻合术 18只犬中有 9只存在不同程度的吻合口狭窄 ,其中 3只已构成梗阻。②一层缝合吻合口表面光滑 ,吻合口疤痕较二层缝合者明显小 ,吻合口通畅宽度大 ,同时吻合部肠管壁的蠕动性较二层缝合好 ,肠粘连程度轻。③一层吻合术比二层吻合术平均缩短 0 .5～ 1.0h。结论 :舰艇航行中枪弹及锐器致腹部伤的一层肠吻合法安全可靠 ,手术简单快捷 ,能为战时流水作业接台手术赢得更多时间。

Objective: To explore the best approach to medical operation on the intestinal canal during naval warfare at sea, and to improve skills and expertise involved in intestinal anatomosis during deployment at sea. Methods: 36 hybrid dogs, out of which 22 were injured with gunshots and 14 with sharp instrument, were randomly divided into 2 groups (each group containing 9 re-operated dogs). The experimental animals were administered with inosculation of the first and second layers of intestinal canals, and then observation was made on the survival and recovery of the treated dogs after operation. Results: (1) Only 2 dogs out of 18 with first layer intestinal anatomosis showed slight stenosis in the anastomotic stoma, but without obvious obstruction, leakage and hemorrhage. 9 out of 18 dogs with second-layer anatomosis showed stenosis to different degrees in anatomotic stoma, and 3 dogs developed obstruction. (2) The surface of anastomotic stoma in the first-layer suture was smooth, with scars obviously smaller than those of the sutured in the second layer and without stoma obstruction, and at the same time, peristalsis of the canal wall was obviously better than the sutured in the second layer. (3) The time spent on the first-layer anatomosis was shortened by 0.5～1.0 h on the average. Conclusion: The first-layer intestinal anatomosis is the right surgical approach to injuries induced by gunshots and sharp instruments in abdomen during deployment at sea. Its features are safety, reliability and easy operation and medical people can respond swiftly to this kind of injury and win more time in the treatment of the casualties.