用氰基丙烯酸酯胶加固结肠吻合口：猪模型

Reinforcement of the colon anastomosis with cyanoacrylate glue: a porcine model.

作者信息

Boersema Geesien S A, Vennix Sandra, Wu Zhouqiao, Te Lintel Hekkert Maaike, Duncker Dirk-Jan G M, Lam King H, Menon Anand G, Kleinrensink Gert-Jan, Lange Johan F

机构信息

Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

出版信息

J Surg Res. 2017 Sep;217:84-91. doi: 10.1016/j.jss.2017.05.001. Epub 2017 May 10.

DOI:10.1016/j.jss.2017.05.001

PMID:28595813

Abstract

BACKGROUND

Previous experimental studies on cyanoacrylate (CA) glue for the prevention of colorectal anastomotic leakage (AL) have shown promising results. The aim of this study was to investigate the effect of CA in prevention of leakage in a porcine model of ischemic colorectal AL.

METHODS

Twenty-four animals were divided into four groups of six: (1)ischemic anastomosis with sufficient suture (ISCH), (2)ischemic anastomosis with sufficient suture and CA reinforcement (CA-ISCH), (3)ischemic anastomosis with insufficient suture (ISCH-AI), and (4)ischemic anastomosis with insufficient suture and CA reinforcement (CA-ISCH-AI). In CA groups, N-butyl-2-cyanoacrylate was applied between the colon ends. Anastomotic bursting pressure, abscess formation, and adhesion formation were evaluated on postoperative day 7. Tissue samples were obtained for histologic evaluation of foreign body reaction.

RESULTS

The AL rate was 4 of 6 (67%) in the ISCH-AI group compared with none in the other three groups. The ISCH and ISCH-AI groups had significantly higher AL scores compared with the CA groups. The mean anastomotic bursting pressure was 167 ± 54 mm Hg in the ISCH-group versus 213 ± 43 mm Hg in the CA-ISCH-group (P = nonsignificant) and 145 ± 102 mm Hg in the ISCH-AI group versus 187 ± 19 mm Hg in the CA-ISCH-AI group (P = nonsignificant). The average adhesion score was significantly higher in the ISCH group than in the CA-ISCH group (4.2 ± 1.3 versus 1.7 ± 0.82; P = 0.019). Stricture of the anastomosis occurred only in the non-CA groups (3/12, 25%).

CONCLUSIONS

Anastomotic reinforcement with CA is effective and safe to prevent leakage in a high-risk colorectal anastomosis in a porcine model.

摘要

背景

先前关于氰基丙烯酸酯（CA）胶水预防结直肠吻合口漏（AL）的实验研究已显示出有前景的结果。本研究的目的是在缺血性结直肠AL的猪模型中研究CA预防漏的效果。

方法

将24只动物分为四组，每组6只：（1）采用充分缝合的缺血性吻合术（ISCH），（2）采用充分缝合并CA加固的缺血性吻合术（CA - ISCH），（3）采用不充分缝合的缺血性吻合术（ISCH - AI），以及（4）采用不充分缝合并CA加固的缺血性吻合术（CA - ISCH - AI）。在CA组中，将正丁基 - 2 - 氰基丙烯酸酯应用于结肠断端之间。在术后第7天评估吻合口破裂压力、脓肿形成和粘连形成情况。获取组织样本进行异物反应的组织学评估。

结果

ISCH - AI组的AL发生率为6只中有4只（67%），而其他三组均无。与CA组相比，ISCH组和ISCH - AI组的AL评分显著更高。ISCH组的平均吻合口破裂压力为167±54 mmHg，而CA - ISCH组为213±43 mmHg（P = 无显著性差异）；ISCH - AI组为145±102 mmHg，而CA - ISCH - AI组为187±19 mmHg（P = 无显著性差异）。ISCH组的平均粘连评分显著高于CA - ISCH组（4.2±1.3对1.7±0.82；P = 0.019）。吻合口狭窄仅发生在非CA组（3/12，25%）。