Mery Carlos M, Shafi Bilal M, Binyamin Gary, Morton John M, Gertner Michael
Biodesign Surgical Innovation Program, Stanford University, 318 Campus Drive, Stanford, CA 94305, USA.
Surg Obes Relat Dis. 2008 May-Jun;4(3):416-22. doi: 10.1016/j.soard.2007.11.008. Epub 2008 Jan 28.
Few studies have been designed to assess the performance of surgical staplers. In this study, we analyzed the effect of staple height, buttressing, and overlapping of staple lines on staple line failure.
Staple lines created on fresh porcine small bowel segments ex vivo were tested for leak pressure by insufflating air into the bowel under water and recording pressure at failure. Three separate experiments were done and included staple height (white, 2.5 mm, n = 16; blue, 3.5 mm, n = 16; green, 4.1 mm, n = 16; one half of them buttressed); the absence (n = 12) or presence (n = 12) of an overlap in 3.5-mm staple lines; and the absence (n = 14) or presence (n = 11) of buttresses in 3.5-mm overlapping staple lines. Data are reported in median values and ranges; nonparametric tests were used for data analysis.
In the porcine small bowel, leak pressure was related to staple height; green loads had the worst profile (35 mm Hg, range 19-105) compared with the blue (79 mm Hg, range 9-177), and white (108 mm Hg, range 28-280) loads (P = .006). Buttressing uniformly improved leak pressure for all staple loads (P <.0001). No significant difference was found between lines with overlapping (59 mm Hg, range 32-121) and those without (42 mm Hg, range 22-75; P = .162). Buttressing also improved the leak pressure of overlapping staple lines from 65 mm Hg (range 47-121) to 93 mm Hg (range 75-187; P = .0014).
Great variability was found in the leak pressures among the different applications of the same stapler. Staple height is an important determinant of leak pressure. The presence of an overlap did not affect leak pressure; in fact, a trend toward improvement was seen with overlapping staple lines. Buttressing improved all types of staple lines.
很少有研究旨在评估手术吻合器的性能。在本研究中，我们分析了钉高、支撑和钉线重叠对钉线失败的影响。
通过在水下向离体的新鲜猪小肠段内注入空气并记录失败时的压力，对所创建的钉线进行漏液压力测试。进行了三项独立实验，包括钉高（白色，2.5毫米，n = 16；蓝色，3.5毫米，n = 16；绿色，4.1毫米，n = 16；其中一半有支撑）；3.5毫米钉线有无重叠（无重叠，n = 12；有重叠，n = 12）；以及3.5毫米重叠钉线有无支撑（无支撑，n = 14；有支撑，n = 11）。数据以中位数和范围报告；使用非参数检验进行数据分析。
在猪小肠中，漏液压力与钉高有关；绿色钉仓的表现最差（35毫米汞柱，范围19 - 105），相比之下蓝色钉仓为（79毫米汞柱，范围9 - 177），白色钉仓为（108毫米汞柱，范围28 - 280）（P = 0.006）。支撑能一致地提高所有钉仓的漏液压力（P < 0.0001）。有重叠的钉线（59毫米汞柱，范围32 - 121）和无重叠的钉线（42毫米汞柱，范围22 - 75；P = 0.162）之间未发现显著差异。支撑还将重叠钉线的漏液压力从65毫米汞柱（范围47 - 121）提高到93毫米汞柱（范围75 - 187；P = 0.0014）。
在同一吻合器的不同应用中，漏液压力存在很大差异。钉高是漏液压力的一个重要决定因素。重叠的存在并不影响漏液压力；事实上，重叠钉线有改善的趋势。支撑改善了所有类型的钉线。
