CAJ | 학술논문

目的比较对合缝合与内翻缝合消化道吻合口微循环及组织愈合过程.方法将成年家兔随机分为A、B两组,距Trietz韧带以远20 cm和40 cm处分别完全切断小肠,行端端吻合,A组在20 cm处吻合口采取对合缝合法,40 cm处吻合口行内翻缝合法;B组则在20 cm处吻合口行内翻缝合法,40 cm处行对合缝合法.于术后3、7、14及28 d进行活体肉眼观察并检测吻合口微区血流和增生毛细血管数量,评估炎性反应、胶原增生、黏膜上皮及平滑肌修复情况.结果活体肉眼观察两组吻合口均无出血、裂开、渗漏以及肠梗阻和腹腔脓肿.对合缝合吻合口各层组织对合严密、整齐,炎性反应轻,创面符合I期愈合;内翻吻合口组织错位,对合不良,炎性反应较重,创面接近Ⅱ期愈合.两种缝合方法术后3 d吻合口处即可测得吻合口局部微区血流,并见微血管增生;7 d开始微区流速加快,微血管增生明显;至28 d,对合缝合吻合口微区血流和微血管分布达到正常水平,但内翻缝合吻合口仍低于正常水平.术后各个检测时间点,对口缝合吻合口微区血流、毛细血管计数、炎性反应积分、黏膜上皮细胞再生积分及平滑肌厚度均高于内翻缝合吻合口,胶原组织密度低于内翻缝合吻合口(P＜0.05).结论采用对合缝合法,吻合口局部微循环重建和各期组织修复均优于内翻缝合法.
목적 비교대합봉합여내번봉합소화도문합구미순배급조직유합과정.방법 장성년가토수궤분위A、B량조,거Trietz인대이원20 cm화40 cm처분별완전절단소장,행단단문합,A조재20 cm처문합구채취대합봉합법,40 cm처문합구행내번봉합법;B조칙재20 cm처문합구행내번봉합법,40 cm처행대합봉합법.우술후3、7、14급28 d진행활체육안관찰병검측문합구미구혈류화증생모세혈관수량,평고염성반응、효원증생、점막상피급평활기수복정황.결과 활체육안관찰량조문합구균무출혈、렬개、삼루이급장경조화복강농종.대합봉합문합구각층조직대합엄밀、정제,염성반응경,창면부합I기유합;내번문합구조직착위,대합불량,염성반응교중,창면접근Ⅱ기유합.량충봉합방법술후3 d문합구처즉가측득문합구국부미구혈류,병견미혈관증생;7 d개시미구류속가쾌,미혈관증생명현;지28 d,대합봉합문합구미구혈류화미혈관분포체도정상수평,단내번봉합문합구잉저우정상수평.술후각개검측시간점,대구봉합문합구미구혈류、모세혈관계수、염성반응적분、점막상피세포재생적분급평활기후도균고우내번봉합문합구,효원조직밀도저우내번봉합문합구(P＜0.05).결론 채용대합봉합법,문합구국부미순배중건화각기조직수복균우우내번봉합법.
Objective To compare microcirculation and tissue healing process in gastrointestinal anastomosis with apposition or inverted suture. Methods The study was performed in adult rabbits.Animals were randomly assigned to two groups. In group A, small intestine was transected at 20 cm and 40 cm from duodenojejunal ligament and apposition sutures were performed at 20 cm and inverted sutures at 40 cm. In group B, transaction and anastomosis were at the same location with group A while the suturing method was reversed. Anastomotic microcirculation and number of capillary were observed in vivo with naked eyes to evaluate inflammatory response, collagen proliferation and healing of epithelium and smooth muscle in both groups at postoperative day 3, 7, 14 and 28. Results In group A, tissue layers at the anastomosis were approximated tight and neat with mild inflammation and primary wound healing. In group B, displacement and poor alignment of layers were seen with severe inflammation and secondary wound healing. Low frequency of microcirculation was detected in group A at day 3, and blood flow velocity significantly increased at day 7. Blood flow velocity was close to normal at day 14 and completely restored to the normal level at day 28. Microcirculation was lower in group A than that in group B at each time point. There were more capillaries, lower number of inflammatory cells, less collagen proliferation, and better healing of anastomotic epithelium and smooth muscle in group A than group B. Conclusion Apposition suturing is better than inverted suturing in restoring local anastomotic microcirculation and healing of intestinal tissues.