双层全层与单层黏膜外肠吻合术在吻合强度和吻合口漏方面的比较。

The comparison of anastomosis strength and leakage between double-layer full-thickness and single-layer extramucosal intestine anastomosis.

作者信息

Akil Fardah, Lusikooy Ronald E, Ulfandi Devby, Faruk Muhammad, Hendarto Joko, Jalil Muhammad R, Sinangka Andi A M, Abdi Amirullah

机构信息

Department of Surgery, Division of Digestive.

Department of Internal Medicine, Division of Gastroenterohepatology.

出版信息

Ann Med Surg (Lond). 2023 Jul 10;85(8):3912-3915. doi: 10.1097/MS9.0000000000001072. eCollection 2023 Aug.

DOI:10.1097/MS9.0000000000001072

PMID:37554861

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10406036/

Abstract

UNLABELLED

Various intestine anastomosis techniques have been studied and used, but which is best is still debated. In our center, double-layer full-thickness intestine anastomosis was still considered as standard. However, a single-layer extramucosal intestine anastomosis has shown favorable results. This study created an anastomotic model to compare the anastomosis strength and leakage between double-layer full-thickness and single-layer extramucosal intestine anastomosis.

METHODS

This experimental study was performed in 20 randomized healthy male pigs, to be included either in Group A (Single-layer extramucosal intestine anastomosis) or Group B (Double-layer full-thickness intestine anastomosis). Enterotomy followed by an end-to-end anastomosis suture was performed in the jejunum. Fourteen days after the operation, any anastomosis leakage and its location was documented. The anastomosis strength was evaluated using manometry. Data were compared between groups using the Mann-Whitney and Fischer Exact test, considering a significance level of <0.05.

RESULTS

The overall mean intraluminal anastomotic bursting pressure was 4,257±1,185. Group A had a higher intraluminal anastomotic bursting pressure but was not statistically significant compared to group B (4.726±0.952 vs. 3.787±1.252 kilopascals, =0.063). One leakage (5%, antimesenteric area) occurred in Group A and three leakages (15%, antimesenteric and mesenteric area) occurred in Group B. However, statistical analysis with Fischer exact showed no significant difference of leakage rate between those groups (=0.291).

CONCLUSIONS

The anastomosis strength and leakage did not differ significantly between the single-layer extramucosal intestine anastomosis group and the double-layer full-thickness anastomosis group. However, the location of leakage was most common in the antimesenteric area in the double-layer full-thickness anastomosis group.

摘要

未标注

已经对多种肠吻合技术进行了研究和应用，但哪种技术最佳仍存在争议。在我们中心，双层全层肠吻合仍被视为标准方法。然而，单层黏膜外肠吻合已显示出良好的效果。本研究创建了一个吻合模型，以比较双层全层和单层黏膜外肠吻合之间的吻合强度和渗漏情况。

方法

本实验研究在20只随机选取的健康雄性猪身上进行，这些猪被分为A组（单层黏膜外肠吻合）或B组（双层全层肠吻合）。在空肠进行肠切开术，然后进行端端吻合缝合。术后14天，记录任何吻合口渗漏情况及其位置。使用测压法评估吻合强度。使用Mann-Whitney和Fischer精确检验对组间数据进行比较，显著性水平设定为<0.05。

结果

腔内吻合口破裂压力的总体平均数值为4257±1185。A组的腔内吻合口破裂压力较高，但与B组相比无统计学显著性差异（4.726±0.952对3.787±1.25千帕斯卡；P = 0.063）。A组发生1例渗漏（5%，系膜对侧区域），B组发生3例渗漏（15%，系膜对侧和系膜区域）。然而，Fischer精确检验的统计分析显示，两组之间的渗漏率无显著差异（P = 0.291）。