Kozol R A, Mulligan M, Downes R J, Forouhar F A, Kreutzer D L
Department of Surgery, University of Connecticut School of Medicine, Farmington 06032.
Dis Colon Rectum. 1988 Jul;31(7):503-6. doi: 10.1007/BF02553721.
Early dysfunction of intestinal anastomoses is sometimes blamed on anastomotic edema. This study compares stapled and hand-sewn anastomoses for the development of early anastomotic edema. After segmental colon resections, one group of dogs was reconstructed with two-layered handsewn anastomoses, and the other group had stapled anastomoses. Controls were untouched small bowel in each operated animal and untouched colon in a separate group of dogs. At 24 hours postoperatively, all animals were given 125I albumin and at 28 hours the animals were killed, venous blood was obtained, and the anastomoses were harvested. Tissue levels of 125I albumin were measured at 1-mm and 1-cm distances from each anastomosis and compared with controls. This quantitative measure of edema was compared with the histologic appearance of the tissue specimens. The results show significant edema formation in both stapled and handsewn anastomoses compared with control tissues (P less than .05 for each animal). Although quantitative and histologic results demonstrate less edema in the stapled group, the difference is not significant by the Wilcoxin rank test. These and similar studies may allow improvement in surgical technique.
肠道吻合口早期功能障碍有时被归咎于吻合口水肿。本研究比较了吻合器吻合和手工缝合吻合在早期吻合口水肿形成方面的情况。在进行节段性结肠切除术后，一组犬采用两层手工缝合吻合进行重建，另一组采用吻合器吻合。对照组为每只手术动物未处理的小肠以及另一组未处理的结肠。术后24小时，所有动物均给予125I白蛋白，术后28小时处死动物，采集静脉血，并取出吻合口。在距每个吻合口1毫米和1厘米处测量125I白蛋白的组织水平，并与对照组进行比较。将这种水肿的定量测量结果与组织标本的组织学表现进行比较。结果显示，与对照组织相比，吻合器吻合和手工缝合吻合均有明显的水肿形成（每只动物P均小于0.05）。虽然定量和组织学结果表明吻合器组的水肿较少，但经威尔科克森秩和检验，差异无统计学意义。这些研究及类似研究可能有助于改进手术技术。
