Fujiwara K, Nakahara K, Fujii Y, Matsumura A, Takeda S, Minami M, Matsuda H
First Department of Surgery, Osaka University Medical School, Japan.
Surgery. 1994 Feb;115(2):227-32.
To examine the beneficial effect of omentopexy for tracheal anastomosis after extensive detachment that may cause impairment of the blood supply, the time course of tracheal wound healing was studied experimentally.
Circumferential resection of the trachea for three cartilage rings (nos. 11, 12, 13) and end-to-end anastomosis of the trachea were performed in 66 mongrel dogs, which were allocated to three groups (n = 22 in each). In the detached group, the trachea was entirely mobilized and isolated from the surrounding tissue for a length of 25 cartilage rings. In the wrapped group, omentopexy was added for the anastomosed site. In the control group, the same anastomosis was performed without omentopexy or detachment. The tracheal tissue blood flow was measured with a laser Doppler flow meter at the anastomosed site, and the tensile strength was determined with a tensiometer.
All groups showed significant decreases in the blood flow on day 3, compared with the preoperative values, and increases stepwise from day 7 to day 21. On days 3, 7, and 14 the tissue blood flow was significantly (p < 0.01) higher in the wrapped group than in the detached group, although on day 21 it did not differ significantly among the three groups. The tensile strengths of the cartilaginous and membranous portions were significantly (p < 0.05) higher in the wrapped and control groups than in the detached group. On day 21, no significant intergroup differences were observed for this parameter. In the wrapped group and in the control group, the capillary network at the anastomosed site was well developed on day 7, and the tracheal mucosal epithelium was well regenerated on day 21 without granulation formation.
This study showed that omentopexy at the anastomosed site of an extensively detached trachea provided adequate wound healing caused by rapid recovery of the tissue blood flow.
为了研究网膜固定术对广泛游离后可能导致血供受损的气管吻合术的有益效果，我们对气管伤口愈合的时间进程进行了实验研究。
在66只杂种犬身上进行了三个气管软骨环（第11、12、13环）的环形切除及气管端端吻合术，并将其分为三组（每组n = 22）。在游离组中，气管被完全游离并与周围组织分离25个软骨环的长度。在包裹组中，网膜固定术应用于吻合部位。在对照组中，进行相同的吻合术，但不进行网膜固定术或气管游离。用激光多普勒血流仪测量吻合部位的气管组织血流量，并用张力计测定抗张强度。
与术前值相比，所有组在第3天血流量均显著下降，并从第7天到第21天逐步增加。在第3、7和14天，包裹组的组织血流量显著高于游离组（p < 0.01），尽管在第21天三组之间无显著差异。包裹组和对照组软骨和膜部的抗张强度显著高于游离组（p < 0.05）。在第21天，该参数在组间未观察到显著差异。在包裹组和对照组中，吻合部位的毛细血管网在第7天发育良好，气管黏膜上皮在第21天完全再生，无肉芽形成。
本研究表明，在广泛游离的气管吻合部位进行网膜固定术，可通过组织血流量的快速恢复实现充分的伤口愈合。
