Haukipuro K A, Hulkko O A, Alavaikko M J, Laitinen S T
Department of Surgery, University of Oulu, Finland.
Dis Colon Rectum. 1988 Aug;31(8):601-4. doi: 10.1007/BF02556795.
The only technique available for creating an intestinal anastomosis without tissue strangulation is gluing. Theoretically, this could lead to a higher hydroxyproline content and greater mechanical strength than in a sutured anastomosis. To test the hypothesis, 83 rats underwent left colon resection and inverted primary anastomosis with either one layer of sutures (NG group) or fibrin glue (FG group). Seven-day FG anastomoses showed less adhesions (P = .02) but one subclinical leakage and a further radiologic one, compared with a greater amount of adhesions but no leakages in the NG group. The mean bursting pressures (mmHg) in the FG and NG groups, respectively, were 25 +/- 20 (SD) and 63 +/- 23 (N.S.) 30 minutes after surgery, 107 +/- 33 and 115 +/- 30 after one day, 81 +/- 31 and 133 +/- 26 (P less than .001) after four days, and 161 +/- 36 and 175 +/- 24 after seven days. The somewhat earlier rise in hydroxyproline content in the glued anastomoses did not lead to significant intergroup differences. The glued anastomoses were thus weak during the critical lag period of healing. Also, by preventing adhesion formation, the glue may reduce the extra blood supply from perianastomotic vessels. The outcomes might have differed more under demanding experimental or clinical situations.
目前唯一可用于创建无组织绞窄的肠道吻合术的技术是粘合。从理论上讲，与缝合吻合术相比，这可能会导致羟脯氨酸含量更高，机械强度更大。为了验证这一假设，83只大鼠接受了左半结肠切除术，并分别用一层缝线（NG组）或纤维蛋白胶（FG组）进行了原位倒置吻合术。与NG组粘连较多但无渗漏相比，FG组在术后7天的粘连较少（P = 0.02），但有1例亚临床渗漏和1例影像学渗漏。FG组和NG组术后30分钟的平均破裂压力（mmHg）分别为25±20（标准差）和63±23（无显著差异），术后1天分别为107±33和115±30，术后4天分别为81±31和133±26（P＜0.001），术后7天分别为161±36和175±24。粘合吻合术中羟脯氨酸含量的上升略早，但未导致组间显著差异。因此，在关键的愈合延迟期，粘合吻合术较为薄弱。此外，通过防止粘连形成，胶水可能会减少吻合口周围血管的额外血液供应。在要求更高的实验或临床情况下，结果可能会有更大差异。
