Kocaeli University Medical Faculty, Department of Pediatric Surgery, Kocaeli, Turkey.
J Pediatr Surg. 2011 Oct;46(10):1923-9. doi: 10.1016/j.jpedsurg.2011.04.062.
The aim of this study is to compare bipolar radiofrequency-driven vessel sealer, bipolar electrocautery, polyglactin 910 sutures, and endoclips in appendiceal stump closure with respect to operative time, appendiceal stump strength, and inflammation in a rat appendiceal model.
Forty-eight Wistar-Albino rats, which had previously created appendicitis, were divided into 2 (groups A and B). Each group was further subdivided into 4 subgroups (AL, ABPC, AC, AS, BL, BBPC, BC, and BS) each containing 6 rats. An appendectomy was performed, and the stump was closed by bipolar radiofrequency-driven vessel sealer in the L, bipolar electrocautery in the BPC, endoclips in the C, and ligatures in the S subgroups. Cecum bursting pressures were determined instantly after the operation in group A and on the seventh postoperative day in group B. All operative times were measured. Appendices and appendiceal stumps underwent histopathologic examination. Statistical analyses were performed with Kruskal-Wallis and Mann-Whitney U tests. P < .05 was considered significant.
Bursting pressures of the subgroups were comparable on postoperative immediate period and day 7. Operative times were significantly shorter in the L and BPC subgroups in A and B. Histopathologic examination showed that the inflammation scores were similar in group A. In group B, inflammation parameters were also similar except the necrosis status, which was found to be decreased in BL compared with BC and BS. Necrosis status was significantly lower, and lymphocyte quantity was significantly higher in BL and BBPC compared with AL and ABPC.
Bipolar radiofrequency-driven vessel sealer and bipolar electrocautery achieve safe stump closure with satisfactory bursting pressure values in an experimental rat appendicitis model. Decreased operative time and unimpaired healing are encouraging.
本研究旨在比较双极射频驱动血管密封器、双极电凝、聚乳酸 910 缝线和肠夹在阑尾残端闭合方面的手术时间、阑尾残端强度和炎症，在大鼠阑尾模型中。
48 只先前患有阑尾炎的 Wistar-Albino 大鼠被分为 2 组（A 组和 B 组）。每组进一步分为 4 个亚组（AL、ABPC、AC、AS、BL、BBPC、BC 和 BS，每组 6 只）。行阑尾切除术，用双极射频驱动血管密封器闭合 L 组、双极电凝器闭合 BPC 组、肠夹闭合 C 组、结扎闭合 S 组的阑尾残端。A 组术后即刻和 B 组术后第 7 天测定盲肠破裂压。测量所有手术时间。阑尾和阑尾残端行组织病理学检查。采用 Kruskal-Wallis 和 Mann-Whitney U 检验进行统计学分析。P <.05 被认为具有统计学意义。
术后即刻和第 7 天，各亚组的破裂压无差异。A 组和 B 组的 L 和 BPC 亚组手术时间明显缩短。组织病理学检查显示 A 组的炎症评分相似。B 组中，除 BL 组的坏死状态较 BC 和 BS 组降低外，炎症参数也相似。BL 和 BBPC 组的坏死状态明显降低，淋巴细胞数量明显高于 AL 和 ABPC 组。
双极射频驱动血管密封器和双极电凝在实验性大鼠阑尾炎模型中可实现安全的残端闭合，具有满意的破裂压值。手术时间缩短，愈合不受影响，令人鼓舞。
