Izumi Yotaro, Kawamura Masafumi, Gika Masatoshi, Nomori Hiroaki
Division of General Thoracic Surgery, Department of Surgery, School of Medicine Keio University, Shinjuku-ku, Tokyo, Japan.
Interact Cardiovasc Thorac Surg. 2010 Mar;10(3):356-9. doi: 10.1510/icvts.2009.219006. Epub 2009 Dec 9.
The aim of this study was to compare the morphology of the bronchial stump after lobectomy between mechanical stapler closure and manual suture closure. The effect of fibrin glue application on each method of closure was also observed. Right upper lobectomy was performed in beagles (n=31) using staplers (ST group) or sutures (SU group). In a separate experiment, fibrin glue was sprayed onto the stump after each respective method of closure. After one week, the stump region was examined macroscopically, and also by histology. chi(2)-Test and Mann-Whitney test were used for comparative analysis. The incidence of adhesion formation between the surrounding tissues was significantly reduced in the ST group in comparison to the SU group (22 vs. 80%, P=0.04). The thickness of granulation tissue over the stump was significantly reduced in the ST group in comparison to the SU group (0.8+/-0.2 vs. 2.5+/-0.3 mm, P<0.0001). Vessel density in the granulation tissue was also significantly reduced in the ST group in comparison to the SU group (6+/-2 vs. 16+/-2, P=0.003). Fibrin glue application after stapler closure significantly increased the incidence of adhesion formation, granulation tissue thickness, and vessel density in the granulation tissue over the stump.
本研究旨在比较肺叶切除术后机械吻合器闭合与手工缝合闭合支气管残端的形态学差异。同时观察纤维蛋白胶应用于每种闭合方法后的效果。使用吻合器（ST组）或缝线（SU组）对31只比格犬进行右上肺叶切除术。在另一个单独的实验中，在每种相应的闭合方法后，将纤维蛋白胶喷洒在残端上。一周后，对残端区域进行大体检查和组织学检查。采用卡方检验和曼-惠特尼检验进行比较分析。与SU组相比，ST组周围组织粘连形成的发生率显著降低（22%对80%，P = 0.04）。与SU组相比，ST组残端上肉芽组织的厚度显著降低（0.8±0.2对2.5±0.3毫米，P < 0.0001）。与SU组相比，ST组肉芽组织中的血管密度也显著降低（6±2对16±2，P = 0.003）。吻合器闭合后应用纤维蛋白胶显著增加了残端上肉芽组织的粘连形成发生率、厚度和血管密度。
