Burugapalli Krishna, Chan Jeffrey C Y, Kelly John L, Pandit Abhay
National Centre for Biomedical Engineering Science, National University of Ireland, Galway, Ireland.
Obes Surg. 2008 Nov;18(11):1418-23. doi: 10.1007/s11695-008-9518-7. Epub 2008 May 6.
Staple line leakage and bleeding are the most common problems associated with the use of surgical staplers for gastrointestinal resection and anastomotic procedures. These complications can be reduced by reinforcing the staple lines with buttressing materials. The current study reports the potential use of cholecyst-derived extracellular matrix (CEM) in non-crosslinked (NCEM) and crosslinked (XCEM) forms, and compares their mechanical performance with clinically available buttress materials [small intestinal submucosa (SIS) and bovine pericardium (BP)] in an ex vivo small intestine model.
Three crosslinked CEM variants (XCEM0005, XCEM001, and XCEM0033) with different degree of crosslinking were produced. An ex vivo peristaltic inflation model was established. Porcine small intestine segments were stapled on one end, using buttressed or non-buttressed surgical staplers. The opened, non-stapled ends were connected to a peristaltic pump and pressure transducer and sealed. The staple lines were then exposed to increased intraluminal pressure in a peristaltic manner. Both the leak and burst pressures of the test specimens were recorded.
The leak pressures observed for non-crosslinked NCEM (137.8 +/- 22.3 mmHg), crosslinked XCEM0005 (109.1 +/- 14.1 mmHg), XCEM001 (150.1 +/- 16.0 mmHg), XCEM0033 (98.8 +/- 10.5 mmHg) reinforced staple lines were significantly higher when compared to non-buttressed control (28.3 +/- 10.8 mmHg) and SIS (one and four layers) (62.6 +/- 11.8 and 57.6 +/- 12.3 mmHg, respectively) buttressed staple lines. NCEM and XCEM were comparable to that observed for BP buttressed staple lines (138.8 +/- 3.6 mmHg). Only specimens with reinforced staple lines were able to achieve high intraluminal pressures (ruptured at the intestinal mesentery), indicating that buttress reinforcements were able to withstand pressure higher than that of natural tissue (physiological failure).
These findings suggest that the use of CEM and XCEM as buttressing materials is associated with reinforced staple lines and increased leak pressures when compared to non-buttressed staple lines. CEM and XCEM were found to perform comparably with clinically available buttress materials in this ex vivo model.
吻合口漏和出血是胃肠切除及吻合手术中使用外科吻合器最常见的问题。使用支撑材料加固吻合线可减少这些并发症。本研究报告了未交联（NCEM）和交联（XCEM）形式的胆囊源性细胞外基质（CEM）的潜在用途，并在离体小肠模型中将它们的力学性能与临床可用的支撑材料[小肠黏膜下层（SIS）和牛心包（BP）]进行比较。
制备了三种交联程度不同的交联CEM变体（XCEM0005、XCEM001和XCEM0033）。建立了离体蠕动充气模型。使用有支撑或无支撑的外科吻合器将猪小肠段一端吻合。将开放的、未吻合的一端连接到蠕动泵和压力传感器并密封。然后以蠕动方式使吻合线承受升高的腔内压力。记录测试样本的漏出压力和破裂压力。
与无支撑对照（28.3±10.8 mmHg）和SIS（一层和四层）（分别为62.6±11.8 mmHg和57.6±12.3 mmHg）支撑的吻合线相比，未交联的NCEM（137.8±22.3 mmHg）、交联的XCEM0005（109.1±14.1 mmHg）、XCEM001（150.1±16.0 mmHg）、XCEM0033（98.8±10.5 mmHg）加固的吻合线的漏出压力显著更高。NCEM和XCEM与BP支撑的吻合线（138.8±3.6 mmHg）观察到的情况相当。只有吻合线加固的样本能够承受高腔内压力（在肠系膜处破裂），表明支撑加固能够承受高于天然组织的压力（生理性衰竭）。
这些发现表明，与无支撑的吻合线相比，使用CEM和XCEM作为支撑材料可使吻合线得到加固并增加漏出压力。在这个离体模型中，发现CEM和XCEM与临床可用的支撑材料表现相当。
