Holland-Cunz S, Chmelnik M, Romero P, Klein B, Rumstadt B
University Hospital Heidelberg, Division of Pediatric Surgery, Heidelberg, Germany.
Eur J Pediatr Surg. 2011 Mar;21(2):103-5. doi: 10.1055/s-0030-1267207. Epub 2010 Nov 4.
Our studies of clipped intestinal non-perforating anastomosis (CINPA) of the small bowel in a rat model have demonstrated that all clips migrated from the outside to the inside of the small bowel during the healing process. The aim of this study was to describe how the clips migrate.
In male Sprague Dawley rats small bowel anastomoses were performed with single, non-perforating metal clips. Bowel specimens were obtained from the anastomosed region for histological examination.
On the day of surgery all clips were situated in the serous membrane. On the first postoperative day, an intramural migration could be observed. By days 6, 8, and 10 no clip was found in the peritoneum. All egested clips were found either in the distal lumen of the bowel or in the solid feces. H&E staining of the anastomoses studies indicated that the bowel wall everts immediately after being cut and becomes more and more inverted during the first few days after being anastomosed.
Our studies showed that the observed dynamic movement of the bowel wall determines the movement of clip migration from the serosal to the mucosal side of the small bowel. In pediatric surgery the observed clip migration would be an important precondition for employing clipped intestinal non-perforating anastomosis (CINPA) routinely. However, further studies are necessary before the technique can be applied in daily practice.
我们在大鼠模型中对小肠的夹闭式肠非穿孔吻合术（CINPA）的研究表明，在愈合过程中，所有夹子都从小肠外部迁移到了内部。本研究的目的是描述夹子如何迁移。
对雄性Sprague Dawley大鼠进行小肠吻合术，使用单个非穿孔金属夹。从吻合区域获取肠标本进行组织学检查。
手术当天，所有夹子都位于浆膜层。术后第一天，可以观察到壁内迁移。到第6、8和10天时，在腹膜中未发现夹子。所有排出的夹子都在肠的远端管腔或固体粪便中发现。吻合术研究的苏木精-伊红染色表明，肠壁在切断后立即外翻，并在吻合后的头几天内越来越内翻。
我们的研究表明，观察到的肠壁动态运动决定了夹子从小肠浆膜侧迁移到黏膜侧的运动。在小儿外科手术中，观察到的夹子迁移将是常规采用夹闭式肠非穿孔吻合术（CINPA）的重要前提条件。然而，在该技术能够应用于日常实践之前，还需要进一步的研究。
