Chung R S
Ann Surg. 1987 Sep;206(3):335-9. doi: 10.1097/00000658-198709000-00011.
Sutureline blood flow was measured with laser Doppler velocimetry in colonic anastomoses created with the stapler, manual suturing, or a combination. Blood flow was always reduced in the sutureline compared with normal mucosa. Of all the anastomoses studied, tight stapling reduced sutureline blood flow the most, whereas the two-layered manual anastomosis or stapling reinforced with sutures were somewhat less ischemic. Stapling adjusted to bowel wall thickness impaired flow only moderately. It was possible with practice to outperform the stapler by single-layered manual anastomosis using fine sutures. In humans, stapled ileocolostomy had a higher sutureline blood flow than the two-layered manual anastomosis. In view of the existing clinical experience of safe stapling without adjustment for bowel wall thickness, a low sutureline blood flow is probably tolerated to a considerable degree in humans. However, this study clearly shows that tight stapling can reduce sutureline blood flow unduly, whereas superior blood supply can be attained by attention to staple closure height relative to bowel wall thickness.
使用激光多普勒测速仪测量用吻合器、手工缝合或两者结合方式创建的结肠吻合口处的缝合线血流情况。与正常黏膜相比，缝合线处的血流总是减少的。在所有研究的吻合口中，紧密吻合使缝合线血流减少最多，而双层手工吻合或用缝线加固的吻合则缺血程度稍轻。根据肠壁厚度调整吻合器对血流的影响仅为中度。通过练习，使用细缝线进行单层手工吻合有可能比吻合器做得更好。在人体中，吻合器行回结肠造口术的缝合线血流比双层手工吻合术的更高。鉴于目前在不根据肠壁厚度进行调整的情况下安全使用吻合器的临床经验，在人体中，较低的缝合线血流可能在很大程度上是可以耐受的。然而，这项研究清楚地表明，紧密吻合会过度减少缝合线血流，而通过注意吻合钉闭合高度与肠壁厚度的关系可以获得更好的血液供应。
