Dockendorf B L, Frazee R C, Matheny R G
Department of Surgery, Scott & White Clinic and Memorial Hospital, Scott, Sherwood and Brindley Foundation, Temple, TX 76508.
South Med J. 1993 Jun;86(6):628-32. doi: 10.1097/00007611-199306000-00007.
An end-to-end anastomosis was done in the center of a 5-cm devascularized jejunal segment in 5 control laboratory rabbits and 14 experimental rabbits. A second group consisted of 5 control animals and 11 experimental animals having end-to-end jejunojejunostomy in the center of a 10-cm devascularized jejunal segment. In the experimental animals, the anastomosis was wrapped circumferentially by a vascularized omental pedicle. Anastomotic leaks or fistulas developed in five 10-cm controls (100%), five 5-cm controls (100%), nine 10-cm omental wraps (82%), and four 5-cm omental wraps (29%). The remaining animals had strictures of various degrees. Injection of methylene blue into the omental vessels showed perfusion to the mucosa from the omentum. The difference between the 10-cm segment and the 5-cm segment indicates some limitation to the available blood flow from the omentum. The anastomotic stricturing was due to ischemic injury before reperfusion by ingrowth of omental vessels. A vascularized omental pedicle wrap can augment blood flow; however, the time required for neovascular ingrowth allows ischemic mucosal injury if there is no other available blood supply.
在5只对照实验兔和14只实验兔的5厘米去血管空肠段中央进行端端吻合。第二组由5只对照动物和11只实验动物组成，在10厘米去血管空肠段中央进行端端空肠吻合术。在实验动物中，吻合口被带血管蒂大网膜环周包裹。吻合口漏或瘘在5只10厘米对照动物（100%）、5只5厘米对照动物（100%）、9只10厘米大网膜包裹动物（82%）和4只5厘米大网膜包裹动物（29%）中出现。其余动物有不同程度的狭窄。向大网膜血管内注射亚甲蓝显示大网膜向黏膜供血。10厘米肠段和5厘米肠段之间的差异表明大网膜可提供的血流存在一定限制。吻合口狭窄是由于大网膜血管长入之前再灌注前的缺血性损伤所致。带血管蒂大网膜包裹可增加血流；然而，如果没有其他可用的血液供应，新生血管长入所需的时间会导致缺血性黏膜损伤。
