Department of Surgery, Riverside Methodist Hospital, Columbus, OH 43214, USA.
Surg Endosc. 2011 Sep;25(9):3043-9. doi: 10.1007/s00464-011-1667-4. Epub 2011 Apr 13.
Anastomotic leak after gastrointestinal anastomosis is a well-known and serious complication, yet there is no standardized approach to reliably create an anastomosis with sufficient mechanical properties to consistently avoid an anastomotic leak. The purpose of this study was to evaluate the relationships among combined tissue thickness, tissue compression, closed staple limb length, and mechanical strength of an anastomosis created with a circular stapler, as measured by maximum intraluminal pressure obtained at the time of leakage.
Using 27 porcine stomachs and 27 porcine small-intestine segments, we measured tissue thickness and assessed the tissue compression at three different anvil closure distances created by a circular stapling device. Maximum intraluminal pressure was determined by infusing colored water into the porcine materials and increasing the pressure until leakage from the anastomosis occurred.
Tissue compression increased as the closure distance narrowed between the anvil and circular stapler (p < .0001). A tissue compression of ≥6 PSI correlated strongly with a maximum intraluminal pressure of ≥18 mmHg (43% for <6 PSI vs. 90% for ≥6 PSI; p = .02); tissue compression ≥12 PSI was necessary to obtain an acute maximum intraluminal pressure of ≥22 mmHg in 13 of 15 of our samples (p = .04).
Maximum intraluminal pressure of an anastomosis in this porcine model correlated most strongly with the compression of the tissue involved in the anastomosis. This experimental model provides a framework for constructing a systematic approach to creating an anastomosis with sufficient mechanical strength. However, this study was not intended to establish the upper range of tissue compression beyond which a permanent tissue injury may occur.
胃肠道吻合术后吻合口漏是一种众所周知且严重的并发症，但目前尚无标准化方法来可靠地创建具有足够机械性能的吻合口，以始终避免吻合口漏。本研究旨在评估在吻合口漏发生时通过最大腔内压力测量获得的圆形吻合器吻合的组织厚度、组织压缩、闭合吻合器钉腿长度和机械强度之间的关系。
使用 27 个猪胃和 27 个猪小肠段，我们测量了组织厚度，并评估了在由圆形吻合器装置创建的三个不同吻合器钉砧闭合距离处的组织压缩情况。通过向猪材料中注入有色水并增加压力直到吻合口泄漏来确定最大腔内压力。
随着吻合器钉砧和圆形吻合器之间的闭合距离变窄，组织压缩增加（p<0.0001）。组织压缩≥6 PSI 与最大腔内压力≥18 mmHg 之间存在强烈相关性（<6 PSI 为 43%，≥6 PSI 为 90%；p=0.02）；需要组织压缩≥12 PSI 才能使 15 个样本中的 13 个获得急性最大腔内压力≥22 mmHg（p=0.04）。
在这个猪模型中，吻合口的最大腔内压力与参与吻合的组织的压缩最密切相关。这个实验模型为创建具有足够机械强度的吻合提供了一个系统方法的框架。但是，本研究的目的不是确定组织压缩的上限，超过该上限可能会发生永久性组织损伤。
