Tajima Masaaki, Kono Yohei, Ninomiya Shigeo, Amin Nwar Tawfik, Inomata Masafumi, Shiraishi Norio, Kitano Seigo
Department of Surgery I, Faculty of Medicine, Oita University, Oita, Japan.
Exp Ther Med. 2012 Aug;4(2):211-215. doi: 10.3892/etm.2012.588. Epub 2012 May 23.
Mechanical stapling for colorectal anastomosis is popular, but the safety of its use for anastomosis in peritonitis is unclear. We evaluated the safety and effectiveness of mechanically stapled vs. hand-sutured anastomosis by comparing wound healing in an animal model of bacterial peritonitis. Male Sprague-Dawley (n=48) rats underwent cecal ligation and puncture. After 24 h, rats were divided into two groups: the stapler group (cecal resection with mechanical stapler, n=24) and the hand-sutured group (cecal resection and stump closure with surgical absorbable suture, n=24). Anastomotic segments were excised and as indicators of wound healing, anastomotic bursting pressure (ABP) and tissue hydroxyproline concentration were determined over time. After harvesting, anastomotic segments were analyzed by quantitative real-time polymerase chain reaction (PCR) to determine relative expression of transforming growth factor-β(1) (TGF-β(1)) and vascular endothelial growth factor (VEGF) normalized to that of a constitutive gene. The operative time was significantly shorter in the stapler vs. the hand-sutured group. Both groups showed progressive increases in ABP over the postoperative period. ABP was significantly higher in the stapler vs. the hand-sutured group on postoperative days (PODs) 0 and 3. Tissue hydroxyproline concentration increased from POD 7 in both groups, but between-group difference was not significant. Both groups showed progressive increases in TGF-β(1) and VEGF expression during the 7-day postoperative period. On POD 5, TGF-β(1) gene expression was higher in the stapler vs. the hand-sutured group. VEGF gene expression was identical in both groups. In conclusion, anastomosis by stapler is safer and more effective than that by hand suturing in bacterial peritonitis, since it requires less operating time and creates stronger anastomoses in the early postoperative period.
机械吻合用于结直肠吻合很常见，但在腹膜炎中使用其进行吻合的安全性尚不清楚。我们通过比较细菌性腹膜炎动物模型中的伤口愈合情况，评估了机械吻合与手工缝合吻合术的安全性和有效性。48只雄性Sprague-Dawley大鼠接受盲肠结扎和穿刺。24小时后，大鼠被分为两组：吻合器组（用机械吻合器进行盲肠切除，n = 24）和手工缝合组（用手术可吸收缝线进行盲肠切除和残端闭合，n = 24）。切除吻合段，作为伤口愈合指标，随时间测定吻合口破裂压力（ABP）和组织羟脯氨酸浓度。取材后，通过定量实时聚合酶链反应（PCR）分析吻合段，以确定转化生长因子-β(1)（TGF-β(1)）和血管内皮生长因子（VEGF）相对于组成型基因的相对表达。吻合器组的手术时间明显短于手工缝合组。两组术后ABP均呈逐渐升高趋势。术后第0天和第3天，吻合器组的ABP明显高于手工缝合组。两组组织羟脯氨酸浓度均从术后第7天开始升高，但组间差异不显著。两组术后7天内TGF-β(1)和VEGF表达均呈逐渐升高趋势。术后第5天，吻合器组的TGF-β(1)基因表达高于手工缝合组。两组VEGF基因表达相同。总之，在细菌性腹膜炎中，吻合器吻合比手工缝合更安全、更有效，因为它所需的手术时间更少，且在术后早期能形成更强的吻合口。
