CAJ | 학술논문

目的探讨探索小儿胆肠吻合术中Roux支长度与临床效果之间的关系.方法 45只1月龄体重(600±60)g清洁级新西兰幼兔按随机数字表法分为:短Roux支组(SRJG)；长Roux支组(LRJG)；空白对照组(CG).记录围手术期并发症、术后活动性和反应性.记录、计算平均手术时间、平均肠鸣音恢复时间、平均觅食水时间和生存率.测量、计算术前、术后2周、1个月、3个月实验各组幼兔的平均头围、平均身长和平均体重.解剖死亡幼兔,查找死因并记录.分析不同袢空肠组(Roux jejunumgroup,RJG)并发症、成功率、对幼兔胃肠道和生长发育的影响.结果 RJG间平均手术时间差异无统计学意义；RJG间平均肠鸣音恢复时间和平均觅食水时间差异无统计学意义,但比CG较明显延长；三组反应性和术后活动性差异无统计学意义.生存率:SRJG 93.34％,LRJG 66.67％;死因主要为Roux支和呼吸道并发症.术后开腹发现:SRJG肠粘连2例,无Roux支扭转；LRJG肠粘连8例,Roux支扭转6例；RJG Roux支平均增长(2.2±0.25)cm/月；CG幼兔无腹腔粘连,空肠平均增长(2.3±0.33) cm/月.RJG 1个月Roux支空肠平均管径(0.63±0.07)cm,与CG(0.8±0.05)cm差异无统计学意义,而3个月Roux支空肠平均管径(0.35±0.08)cm较CG(0.8±0.05)cm明显缩小.术前三组平均头围、平均身长和平均体重差异无统计学意义；术后2周RJG比CG降低,差异有统计学意义,而RJG之间无明显差异；术后1个月和3个月LRJG低于SRJG和CG,但后两组差异无统计学意义.术后3个月上消化道造影及造影后开腹发现:LRJG和SRJG幼兔均无反流.结论 SRJG并发症少术后恢复快,因而小儿胆肠吻合术中短的个体化的Roux支空肠可能并发症较少,更利于小儿术后恢复和生长发育.
목적 탐토탐색소인담장문합술중Roux지장도여림상효과지간적관계.방법 45지1월령체중(600±60)g청길급신서란유토안수궤수자표법분위:단Roux지조(SRJG)；장Roux지조(LRJG)；공백대조조(CG).기록위수술기병발증、술후활동성화반응성.기록、계산평균수술시간、평균장명음회복시간、평균멱식수시간화생존솔.측량、계산술전、술후2주、1개월、3개월실험각조유토적평균두위、평균신장화평균체중.해부사망유토,사조사인병기록.분석불동번공장조(Roux jejunumgroup,RJG)병발증、성공솔、대유토위장도화생장발육적영향.결과 RJG간평균수술시간차이무통계학의의；RJG간평균장명음회복시간화평균멱식수시간차이무통계학의의,단비CG교명현연장；삼조반응성화술후활동성차이무통계학의의.생존솔:SRJG 93.34％,LRJG 66.67％;사인주요위Roux지화호흡도병발증.술후개복발현:SRJG장점련2례,무Roux지뉴전；LRJG장점련8례,Roux지뉴전6례；RJG Roux지평균증장(2.2±0.25)cm/월；CG유토무복강점련,공장평균증장(2.3±0.33) cm/월.RJG 1개월Roux지공장평균관경(0.63±0.07)cm,여CG(0.8±0.05)cm차이무통계학의의,이3개월Roux지공장평균관경(0.35±0.08)cm교CG(0.8±0.05)cm명현축소.술전삼조평균두위、평균신장화평균체중차이무통계학의의；술후2주RJG비CG강저,차이유통계학의의,이RJG지간무명현차이；술후1개월화3개월LRJG저우SRJG화CG,단후량조차이무통계학의의.술후3개월상소화도조영급조영후개복발현:LRJG화SRJG유토균무반류.결론 SRJG병발증소술후회복쾌,인이소인담장문합술중단적개체화적Roux지공장가능병발증교소,경리우소인술후회복화생장발육.
Objective To explore the relationship between clinical results and the length of Roux jejunum for Roux-en-y hepatoenterostomy in juvenile rabbits.Methods Forty-five New Zealand juvenile rabbits were randomly divided into 3 groups:short roux jejunum group (SRJG,n =15),long rouxjejunum group (LRJG,n =15) and control group (CG,n =15).During operation,medial operating time (MOT) and perioperative complications (PC) were recorded.After operation,sensitivity evaluation (SE),mobility evaluation (ME),medial bowel sound time (MBST) and medial seeking water and food time (MSWFT) of the rabbits were recorded.Survive rate (SR) of three groups and effects on growth and development of juvenile rabbits were compared and analyzed.Results There was no significant difference of MOT between SRJG and LRJG group.MBST and MSWFT were also no significant difference between RJGs but were significant longer in RJGs than those in CG.SE and ME were the same in RJG as those in CG.SR was 93.34％ in SRJG and 66.67％ in LRJG.The causes for death were complications of air way and Roux jejunum.Intestinal adhesion was fewer in SRJG and in CG than that in LRJG under laparotomy observation.Roux jejunum volvulus was not detected in SRJG but occurred in 6 cases of LRJG.The growth length of Roux jejunum was 2.2 ± 0.25 cm monthly in RJG and 2.3 ± 0.33 cm monthly in CG.The medial diameter of Roux jejunum was 0.63 ± 0.07 cm in RJG and 0.8 ± 0.05 cm in CG in the 1st Post-op month,while it was 0.35 ± 0.05 cm in RJG in the 3rd Post-op month,which was deceased significantly.MHC,MBL and MW showed no significant difference before operation and were decreased in RJG in the 2nd Post-op week and were decreased in LRJG in the 1st and the 3rd Post-op month..Upper gastrointestinal contrast and laparotomy observation in the 3rd Post-op month,no reverse flow in Roux jejunum was noted.Conclusions SRJ is the fittest Roux jejunum for Roux-en-y hepatoenterostomy in juvenile rabbits.Short adjusted-customized roux jejunum in Roux-en-y bilioenterostomy with fewer complications may be in favor of the Post-op recovery,growth and development of the children.