Nahai F, Lamb J M, Havican R G, Stone H H
Am Surg. 1977 Jan;43(1):45-51.
Bowel anastomoses, as performed on 181 dogs, were studied: (1) by interposing segments of colon into small bowel and vice versa, (2) by comparing clean anastomoses to those contaminated by feces before and after suturing, (3) with and without parenteral preoperative antibiotic, and (4) with and without coaptation of an inverted serosa. All animals with a timed sacrifice as well as an unexplained death had careful autopsy. Results demonstrated no difference in the healing capacity of large (91%) versus small (92%) intestine under identical circumstances. Intraluminal bacteria were of importance only if spillage caused contamination during operation and thereby subsequent infection of the peritoneal surface of the suture line. Peritonitis preceded all 28 leaks, yet the converse never occurred. Likelihood of a complicating peritonitis (67%) and thus an anastomotic leak (24%) was significantly reduced through the preoperative administration of prophylactic cefazolin (19 and 4%, respectively). A "serosal seal" also appeared important in obviating suture line disruption. Our data emphasize the value of an inverted and serosal lined anastomosis, bowel preparatory measures, prophylactic antibiotic, and the disruptive action of local bacterial peritonitis.
对181只狗进行了肠吻合术研究：（1）将结肠段插入小肠，反之亦然；（2）比较清洁吻合口与缝合前后被粪便污染的吻合口；（3）术前使用或不使用肠外抗生素；（4）吻合时采用或不采用翻转浆膜覆盖。所有按预定时间处死以及不明原因死亡的动物均进行了仔细尸检。结果表明，在相同情况下，大肠（91%）和小肠（92%）的愈合能力没有差异。仅当手术过程中肠内容物溢出导致污染并进而引起缝合线腹膜表面感染时，腔内细菌才具有重要性。所有28例吻合口漏均先有腹膜炎，但反之则从未发生。术前预防性使用头孢唑林可显著降低并发腹膜炎的可能性（从67%降至19%），从而也降低吻合口漏的可能性（从24%降至4%）。“浆膜封闭”对于避免缝合线破裂似乎也很重要。我们的数据强调了翻转并带有浆膜内衬的吻合术、肠道准备措施、预防性抗生素以及局部细菌性腹膜炎的破坏作用的价值。
