Ersoy Omer Faik, Ozkan Namik, Celik Alper, Kayaoglu Huseyin Ayhan, Cakir Ebru
Department of General Surgery, Gaziosmanpasa University Faculty of Medicine, Tokat, Turkey.
Minim Invasive Ther Allied Technol. 2009;18(4):225-31. doi: 10.1080/13645700903062387.
The aim of the study was to compare suture, clip and clip combined with topical N-butyl cyanoacrylate in an experimental model of gastric perforation. Sixty Wistar-Albino rats were divided into three groups. Midline laparotomy was performed and a 4 mm puncture was done on the anterior surface of the stomach. Closure was performed by sutures in the first group, clip in the second group, and clip with topical cyanoacrylate in the third group. Ten rats underwent a re-laparotomy on the 3(rd) and 7(th) days, respectively. Intraabdominal adhesions, burst pressures, procedural time, total operation time and histological evaluation were analyzed. In the early phase, clip with topical cyanoacrylate treatment significantly improved burst pressures (p=0.001). In the late phase, burst pressure levels were slightly higher in the third group. Procedural period and total operation times were significantly higher in the suture-treated group and lower in the clip group. Clip with topical cyanoacrylate treatment improved histological healing indices, with significant difference in granulation, chronic inflammation and collagenisation scores, but at the expense of a significantly increased adhesion formation (P=0.001). Our study shows that gastric perforations can be effectively treated by the combination of clip and cyanoacrylate with shorter time and acceptable side-effects in selected cases.
本研究的目的是在胃穿孔实验模型中比较缝合、钛夹以及钛夹联合局部应用氰基丙烯酸正丁酯的效果。将60只Wistar白化大鼠分为三组。行正中剖腹术，并在胃前壁做一个4毫米的穿刺孔。第一组采用缝合进行闭合，第二组采用钛夹，第三组采用钛夹并局部应用氰基丙烯酸正丁酯。分别有10只大鼠在第3天和第7天接受再次剖腹术。分析腹腔粘连情况、破裂压力、操作时间、总手术时间以及组织学评估结果。在早期，钛夹联合局部应用氰基丙烯酸正丁酯治疗显著提高了破裂压力（p=0.001）。在后期，第三组的破裂压力水平略高。缝合治疗组的操作时间和总手术时间显著更长，而钛夹组则较短。钛夹联合局部应用氰基丙烯酸正丁酯治疗改善了组织学愈合指标，在肉芽组织、慢性炎症和胶原化评分方面有显著差异，但代价是粘连形成显著增加（P=0.001）。我们的研究表明，在特定情况下，钛夹和氰基丙烯酸正丁酯联合应用可以有效治疗胃穿孔，且时间更短，副作用可接受。
