Raboff W, Calobrace M B, Anthony G, Garner D, Greenwald D, Brant A, Hopkins B, Soonthon V, Noonan T, Hofstetter W
Department of Surgery, University of Southern California School of Medicine, Los Angeles 90033.
Am Surg. 1994 Oct;60(10):721-7.
We tested the hypothesis that reinforcement of small bowel anastomoses with polyglycolic acid mesh (PGAM) would increase bursting strength in steroid-treated subjects. Twenty-two New Zealand white rabbits weighing 3-4 kg received methylprednisolone 0.2 mg/kg/day IM for 7-13 days preoperatively and until killed 4-5 days postoperatively. Steroid effect was confirmed by a 58.3 per cent decrease in absolute lymphocyte count and a histologic reduction in anastomotic fibroblast proliferation and collagen deposition. Two small bowel anastomoses were performed in each animal using standard two-layer suture technique. One of the two anastomoses, randomly assigned, was circumferentially reinforced with PGAM such that each animal served as its own control. Anastomotic bursting pressures, determined on postoperative Day 4-5, were significantly higher in mesh-reinforced anastomoses (P = 0.003). Histologic examination of the reinforced anastomoses revealed a well-developed layer of fibroblasts and collagen between the PGAM and bowel wall serosa. These results demonstrate that polyglycolic acid mesh reinforcement significantly increases the bursting strength of small bowel anastomoses in steroid-treated rabbits.
用聚乙醇酸网片（PGAM）加强小肠吻合术可提高接受类固醇治疗的受试者的吻合口破裂强度。22只体重3 - 4千克的新西兰白兔在术前7 - 13天接受甲基强的松龙0.2毫克/千克/天肌肉注射，术后4 - 5天处死前持续给药。绝对淋巴细胞计数下降58.3%以及吻合口成纤维细胞增殖和胶原沉积的组织学减少证实了类固醇的作用。每只动物采用标准的两层缝合技术进行两处小肠吻合术。随机分配，两处吻合口中的一处用PGAM进行环周加强，使每只动物作为自身对照。在术后第4 - 5天测定的吻合口破裂压力显示，网片加强的吻合口显著更高（P = 0.003）。对加强吻合口的组织学检查显示，在PGAM和肠壁浆膜之间有一层发育良好的成纤维细胞和胶原。这些结果表明，聚乙醇酸网片加强显著提高了类固醇治疗的兔小肠吻合口的破裂强度。
