Komen Niels, van der Wal Hans-Christiaan, Ditzel Max, Kleinrensink Gert-Jan, Jeekel Hans, Lange Johan F
Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
J Surg Res. 2009 Jul;155(1):7-12. doi: 10.1016/j.jss.2008.08.019. Epub 2008 Sep 16.
Anastomotic leakage is the major complication after colorectal surgery. To date, animal experiments concerning colorectal anastomosis focus on anastomotic healing instead of anastomotic leakage. This study aims to develop a new experimental model for colorectal anastomotic leakage.
A control group, receiving an anastomosis with 12 interrupted sutures, was compared to a group receiving an anastomosis with 6 interrupted sutures. When the leakage rate was observed to be too low, the number of sutures was decreased stepwise, to 5 or less. Each group contained 9 "C57Bl6-mice". After 7 d the Anastomotic Bursting Pressure (ABP) was determined.
In the first experiment, one mouse (11.1%) in the case group and none in the control group developed leakage. Average ABP was 152.2 mmHg in the control group and 138,8 mmHg in the case group (P=0.111). In the second experiment, case group receiving an anastomosis with 5 sutures, 4 mice (44.4%) in the case group developed leakage. This experiment was repeated twice resulting in leakage rates of 33.3% and 44.4%. The average overall ABP in the case group was 142.7 mmHg vs. 179.9 mmHg (P=0.022) in the control group. The mice without leakage showed a stabilization of average weight loss around day 2 and 3 and a decrease afterwards. The mice with leakage showed a decrease only after day 5. The difference in wellness-scores between the groups with- and without leakage was 2 points, increasing during follow-up.
The model of anastomotic leakage caused by creating an anastomosis with 5 interrupted sutures is feasible. Weight loss and wellness-scores are good predictors of leakage.
吻合口漏是结直肠手术后的主要并发症。迄今为止，关于结直肠吻合的动物实验主要关注吻合口愈合而非吻合口漏。本研究旨在建立一种新的结直肠吻合口漏实验模型。
将接受12针间断缝合吻合的对照组与接受6针间断缝合吻合的组进行比较。当观察到漏出率过低时，逐步减少缝合针数至5针或更少。每组包含9只“C57Bl6小鼠”。7天后测定吻合口破裂压力（ABP）。
在第一个实验中，病例组有1只小鼠（11.1%）发生漏出，对照组无小鼠发生漏出。对照组平均ABP为152.2 mmHg，病例组为138.8 mmHg（P = 0.111）。在第二个实验中，病例组接受5针缝合的吻合，该组有4只小鼠（44.4%）发生漏出。该实验重复两次，漏出率分别为33.3%和44.4%。病例组平均总体ABP为142.7 mmHg，对照组为179.9 mmHg（P = 0.022）。未发生漏出的小鼠在第2天和第3天左右平均体重减轻趋于稳定，之后体重下降。发生漏出的小鼠仅在第5天后体重下降。有漏出和无漏出组之间的健康评分差异为2分，随访期间差异增大。
通过5针间断缝合建立吻合口漏的模型是可行的。体重减轻和健康评分是漏出的良好预测指标。
