Geevarghese S K, Bradley A L, Atkinson J, Wright J K, Chapman W C, Van Buren D H, Blair K T, Hutchins C H, Jabbour K, Phillips J, Williams P E, Pinson C W
Division of Hepatobiliary Surgery and Liver Transplantation, S.R. Light Surgical Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
Am Surg. 1999 Apr;65(4):311-6.
Attempts at improving anastomoses have included the development of stapling techniques. Our purpose was to evaluate arcuate-legged clipped versus standard sutured anastomoses of the hepatic artery (HA), portal vein (PV), and bile duct in a porcine liver transplantation model. Two groups of pigs were studied intraoperatively and 1 day after liver transplantation. A control group underwent sutured anastomosis of PV and HA with polypropylene and of bile duct with polydioxanone (n = 8). An experimental group underwent anastomoses with arcuate-legged clips (n = 8). We analyzed the time to perform anastomosis and flows before and at various time points after anastomosis. In addition, patency and histology of the anastomoses were evaluated 1 day after operation, including a fibrin-thrombosis score, medial injury, and inflammation score. Times to complete HA and PV anastomoses were not different between clipped and sutured groups. However, the time was shorter to complete bile duct anastomosis with clips than with sutures (6.3 +/- 1.1 minutes and 13.3 +/- 2.0 minutes, respectively). Flows through HA anastomoses were not different between groups, but flow through the PV was higher in clipped compared with sutured anastomosis (P = 0.06). Patency was 100 per cent with no leaks for all three anastomoses in both groups. Histologic data were similar between vascular anastomotic groups. Sutured bile duct anastomoses revealed mild smooth muscle injury in 75 per cent whereas clipped bile duct anastomoses displayed no smooth muscle injury. We conclude that arcuate-legged clipped anastomosis represents a viable option to sutured anastomoses of the PV, HA, and bile duct anastomoses. Bile duct anastomoses were completed in less than half the time and with less tissue damage documented histologically.
改善吻合术的尝试包括吻合器技术的发展。我们的目的是在猪肝移植模型中评估弧形腿夹闭与标准缝合的肝动脉（HA）、门静脉（PV）和胆管吻合术。两组猪在肝移植术中及术后1天进行研究。对照组用聚丙烯对PV和HA进行缝合吻合，用聚二氧六环酮对胆管进行缝合吻合（n = 8）。实验组用弧形腿夹进行吻合（n = 8）。我们分析了吻合时间以及吻合前和吻合后不同时间点的血流情况。此外，术后1天评估吻合口的通畅情况和组织学，包括纤维蛋白血栓形成评分、中层损伤和炎症评分。夹闭组和缝合组完成HA和PV吻合的时间没有差异。然而，用夹子完成胆管吻合的时间比用缝线短（分别为6.3±1.1分钟和13.3±2.0分钟）。两组间HA吻合口的血流没有差异，但与缝合吻合相比，夹闭的PV血流更高（P = 0.06）。两组中所有三种吻合口的通畅率均为100%，无渗漏。血管吻合组之间的组织学数据相似。缝合的胆管吻合显示75%有轻度平滑肌损伤，而夹闭的胆管吻合未显示平滑肌损伤。我们得出结论，弧形腿夹闭吻合是PV、HA和胆管吻合的一种可行替代缝合吻合的方法。胆管吻合时间不到一半，且组织学记录显示组织损伤较小。
