Kimura Masahiro, Terashita Yukio
Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
Ann Med Surg (Lond). 2016 Jan 23;6:50-5. doi: 10.1016/j.amsu.2016.01.034. eCollection 2016 Mar.
Few studies have been designed regarding optimal reinforcement of the crotch of a side-to-side anastomosis. The purpose of this study was to clarify the weak point of the side-to-side anastomosis and to evaluate the effect of bioabsorbable reinforcement material.
Fresh pig small bowel was used for all experiments. A side-to-side anastomosis was performed using a linear stapler, and the burst pressure of the anastomosis was measured. Three separate experiments were done. In experiment 1, the weak point and the burst pressure of that point were defined. In experiment 2, the burst pressure of the side of the anastomosis was measured. In experiment 3, we evaluated the effect of Neoveil(®) to strengthen the weak point of the anastomosis.
The weak point of the side-to side anastomosis was the crotch and the burst pressure was 39.8 ± 5.7 mmHg. The burst pressure of the side of the anastomosis was 109.9 ± 7.9 mmHg. This was significantly higher than the burst pressure of the crotch (P = 0.008). The burst pressure of the crotch in the group with Neoveil(®) was 83.3 ± 14.9 mmHg. This pressure was significantly higher than the group with no Neoveil(®) reinforcement (P = 0.001).
These findings suggest that the use of Neoveil(®) as a buttressing material is associated with reinforced staple lines and increased crotch burst pressures compared to non-buttressed staple lines. Neoveil(®) was found to perform comparably to clinically available buttress materials in this ex vivo model. Reinforcement of the weak point of the side-to-side anastomosis with Neoveil(®)may lead to fewer anastomotic leaks.
关于侧侧吻合口裆部最佳加固的研究设计较少。本研究的目的是阐明侧侧吻合的薄弱点，并评估生物可吸收加固材料的效果。
所有实验均使用新鲜猪小肠。使用线性吻合器进行侧侧吻合，并测量吻合口的破裂压力。进行了三个独立的实验。在实验1中，确定薄弱点及其破裂压力。在实验2中，测量吻合口侧面的破裂压力。在实验3中，我们评估了Neoveil®加强吻合薄弱点的效果。
侧侧吻合的薄弱点是裆部，破裂压力为39.8±5.7mmHg。吻合口侧面的破裂压力为109.9±7.9mmHg。这显著高于裆部的破裂压力（P=0.008）。使用Neoveil®的组中裆部的破裂压力为83.3±14.9mmHg。该压力显著高于未使用Neoveil®加固的组（P=0.001）。
这些发现表明，与未支撑的吻合钉线相比，使用Neoveil®作为支撑材料可使吻合钉线得到加强，并增加裆部破裂压力。在这个体外模型中，发现Neoveil®的性能与临床可用的支撑材料相当。用Neoveil®加强侧侧吻合的薄弱点可能会减少吻合口漏。
