Rimereit Jon Erlend, Lindgren Carl Gunnar William, Nerup Nikolaj, Madsen Gunvor Iben, Le Dang Quang Svend, Möller Sören, Qvist Niels, Ellebaek Mark Bremholm
Research Unit for Surgery, Odense University Hospital, Odense, Denmark.
University of Southern Denmark, Odense, Denmark.
Scand J Gastroenterol. 2025 Jan;60(1):54-61. doi: 10.1080/00365521.2024.2433541. Epub 2024 Dec 5.
Anastomotic leakage is a severe complication with multifactorial aetiology, including impaired tissue oxygenation, infection, inflammation, and anastomotic tension. Reinforcement with poly-ε-caprolactone (PCL) scaffold incorporated in a stapled intestinal anastomosis has demonstrated a significant increase in the anastomotic tensile strength. This study aimed to investigate whether incorporation of the scaffold would influence tensile strength with induced ischemia compared to normal blood perfusion.
Eighteen pigs were randomly allocated into an intervention group with a induced relative reduction in blood perfusion to 30% at the anastomotic area and a control group with normal perfusion controlled by quantitative fluorescence angiography. Each pig recieved two stapled small intestinal anastomoses, one with a PCL scaffold incorporated and one without. On postoperative day five, the anastomoses were subjected to a maximal tensile strength test (MATS) and a histopathological analysis. Tensile strength was measured at three events: when a serosal tear became visible (MATS-1), at transmural rupture (MATS-2), and at maximum load before the load-strain curve dropped (MATS-3).
In the intervention group, MATS-1 was significantly higher in scaffold-reinforced anastomoses compared to controls (7.9 ± 4.2N and 4.4 ± 2.5N, < 0.02). The same tendency was found for MATS-2 and MATS-3, with statistically significant differences after adjusting for adhesion grade ( < 0.05). Histological analysis revealed no significant differences in wound healing between groups.
Incorporating a PCL scaffold in a stapled small intestinal anastomosis with induced ischemia improved anastomotic tensile strength.
吻合口漏是一种病因多因素的严重并发症，包括组织氧合受损、感染、炎症和吻合口张力。在吻合器小肠吻合术中使用聚ε-己内酯（PCL）支架进行加固已证明吻合口抗张强度显著增加。本研究旨在探讨与正常血液灌注相比，植入支架是否会影响诱导缺血时的抗张强度。
18头猪被随机分为干预组和对照组，干预组在吻合口区域诱导相对血流灌注减少至30%，对照组通过定量荧光血管造影控制正常灌注。每头猪接受两个吻合器小肠吻合术，一个植入PCL支架，一个未植入。术后第5天，对吻合口进行最大抗张强度测试（MATS）和组织病理学分析。在三个事件时测量抗张强度：浆膜撕裂可见时（MATS-1）、全层破裂时（MATS-2）以及负荷-应变曲线下降前的最大负荷时（MATS-3）。
在干预组中，支架加固的吻合口的MATS-1显著高于对照组（7.9±4.2N和4.4±2.5N，P<0.02）。MATS-2和MATS-3也有相同趋势，在调整粘连分级后有统计学显著差异（P<0.05）。组织学分析显示两组间伤口愈合无显著差异。
在诱导缺血的吻合器小肠吻合术中植入PCL支架可提高吻合口抗张强度。
