Aslan A, Elpek O
Pediatric Surgery, Akdeniz University School of Medicine, Antalya, Turkey.
Eur J Pediatr Surg. 2009 Dec;19(6):384-7. doi: 10.1055/s-0029-1241172.
Aim of the study was to test the safety and efficacy of sutureless colorectal anastomosis using bipolar coagulation.
Thirty-six Wistar albino rats were used. The rectum just proximal to the peritoneal reflection was transected in 22 rats (Group 1), and the bowel ends were anastomosed or welded end-to-end using bipolar coagulating forceps (Scoville-Greenwood, 60-1765-001, ConMed, USA). Coagulation using 60 milliamperes took one second for each weld. In 14 rats (Group 2), bowel anastomosis was carried out by hand-sewn sutures. The animals were followed up for general condition and body weight, and were sacrificed at six weeks. The anastomoses were studied with regard to burst pressure, stenosis and histopathology.
All rats survived, and body weight gain was significant (p<0.01 for Group 1, p<0.05 for Group 2). There were no intraabdominal complications (leakage, obstruction, etc.), except in one rat (in Group 2), who had intraabdominal abscess. Although intraluminal pressure was increased to 40 cm H2O with extensive stretching of the colorectal segment, the anastomoses did not burst or open in either the sutureless or sutured groups. The bowel diameter 1 cm distal and 1 cm proximal to the anastomoses did not show any difference between both groups. Neomucosa completely covered 78% of sutured anastomoses and 36% of sutureless anastomoses (p<0.05). Inflammation developed in 78% of sutured anastomoses and 36% of sutureless anastomoses (p<0.05). Edema, giant cell and mast cell infiltration were equivalent in both anastomoses. Lymphoid tissue hyperplasia markedly appeared in the sutureless anastomoses (p<0.01).
This simple technique of sutureless colorectal anastomosis may be useful and offer an alternative to other colorectal anastomosis techniques.
本研究旨在测试使用双极电凝进行无缝合结直肠吻合术的安全性和有效性。
使用36只Wistar白化大鼠。在22只大鼠（第1组）中，将直肠在腹膜反折近端处横断，肠断端使用双极电凝钳（Scoville - Greenwood，60 - 1765 - 001，ConMed，美国）进行端端吻合或焊接。每次焊接使用60毫安电流持续一秒。在14只大鼠（第2组）中，通过手工缝合进行肠吻合。对动物的一般状况和体重进行随访，并在六周时处死。对吻合口进行破裂压力、狭窄和组织病理学研究。
所有大鼠均存活，体重增加显著（第1组p<0.01，第2组p<0.05）。除一只大鼠（第2组）发生腹腔脓肿外，无腹腔内并发症（渗漏、梗阻等）。尽管通过广泛拉伸结直肠段将腔内压力增加至40 cm H₂O，但无缝合组和缝合组的吻合口均未破裂或裂开。两组吻合口远端1 cm和近端1 cm处的肠直径无差异。新黏膜完全覆盖了78%的缝合吻合口和36%的无缝合吻合口（p<0.05）。78%的缝合吻合口和36%的无缝合吻合口出现炎症（p<0.05）。两组吻合口中水肿、巨细胞和肥大细胞浸润情况相当。无缝合吻合口中明显出现淋巴组织增生（p<0.01）。
这种简单的无缝合结直肠吻合技术可能有用，并为其他结直肠吻合技术提供了一种替代方法。
