Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
Plastic Surgery Research Laboratory, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
Lasers Surg Med. 2022 Mar;54(3):407-417. doi: 10.1002/lsm.23485. Epub 2021 Oct 19.
Gastrointestinal anastomotic leakage is a dreaded complication despite advancements in surgical technique. Photochemical tissue bonding (PTB) is a method of sealing tissue surfaces utilizing photoactive dye. We evaluated if crosslinked human amniotic membrane (xHAM) photosealed over the enteroenterostomy would augment anastomotic strength in a trauma-relevant swine hemorrhagic shock model.
Yorkshire swine (40-45 kg, n = 14) underwent midline laparotomy and sharp transection of the small intestine 120 cm proximal to the ileocecal fold. Immediately following intestinal transection, a controlled arterial bleed was performed to reach hemorrhagic shock. Intestinal repair was performed after 60 minutes and autotransfusion of the withdrawn blood was performed for resuscitation. Animals were randomized to small intestinal anastomosis by one of the following methods (seven per group): suture repair (SR), or SR with PTB augmentation. Animals were euthanized at postoperative Day 28 and burst pressure (BP) strength testing was performed on all excised specimens.
Mean BP for SR, PTB, and native tissue groups were 229 ± 40, 282 ± 21, and 282 ± 47 mmHg, respectively, with the SR group statistically significantly different on analysis of variance (p = 0.02). Post-hoc Tukey all-pairs comparison demonstrated a statistically significant difference in burst pressure strength between the SR only and the PTB group (p = 0.04). All specimens in SR group ruptured at the anastomosis upon burst pressure testing, while all specimens in the PTB group ruptured at least 2.5 cm from the anastomosis.
Photosealing with xHAM significantly augments the strength of small intestinal anastomosis performed in a trauma porcine model.
尽管手术技术有所进步，但胃肠道吻合口漏仍然是一种可怕的并发症。光化学组织结合（PTB）是一种利用光活性染料密封组织表面的方法。我们评估了交联人羊膜（xHAM）在肠肠吻合口上光密封是否会增强与创伤相关的猪失血性休克模型中的吻合强度。
约克夏猪（40-45kg，n=14）行正中剖腹术，并在回盲襻上方 120cm 处锐性横断小肠。小肠横断后立即进行控制性动脉出血，达到失血性休克。60 分钟后进行肠修复，并进行抽出血液的自体输血以进行复苏。动物随机分为以下方法之一的小肠吻合术（每组 7 只）：缝合修复（SR）或 SR 加 PTB 增强。所有切除标本均在术后第 28 天进行爆破压力（BP）强度测试，并对所有切除标本进行爆破压力（BP）强度测试。
SR、PTB 和天然组织组的平均 BP 分别为 229±40、282±21 和 282±47mmHg，方差分析显示 SR 组差异有统计学意义（p=0.02）。Tukey 事后全对比较显示 SR 组和 PTB 组之间的爆破压力强度差异有统计学意义（p=0.04）。SR 组所有标本在爆破压力测试时均在吻合口处破裂，而 PTB 组所有标本均至少在吻合口 2.5cm 处破裂。
光化学组织结合 xHAM 显著增强了创伤性猪模型中小肠吻合的强度。
