Christensen H, Langfelt S, Laurberg S
Institute of Experimental Clinical Research, Aarhus County Hospital, Denmark.
Eur Surg Res. 1993 Jan-Feb;25(1):38-45. doi: 10.1159/000129255.
This study was performed to evaluate the validity of the bursting strength test of experimental anastomoses. By a combination of measuring the intraluminal physiological pressure during the test procedure with a radiological detection of the anastomosed intestinal segment until disruption it was demonstrated that the bursting pressure is a meaningful parameter since the maximum pressure equals the time of anastomotic leak. At day 6 60% of the tested segments disrupted outside the anastomotic line. This indicates that the bursting strength test is not a valid measure for determining the strength of colonic anastomoses after the 4th to 5th postoperative day. Moreover, the bursting wall tension parameter was evaluated. Assessment of the anastomotic radius demonstrated significant differences when the anastomotic radius at disruption was determined from the amount of inflated contrast compared with the radius detected radiologically. These differences had the effect that the wall tension at burst compared with the wall tension determined from direct radius measurement on day 4 was 61% higher than the wall tension determined from the amount of inflated contrast with no correction for elongation of the tested segment, and 36% higher than the wall tension determined from the amount of inflated contrast and corrected for elongation of the segment. No differences in the bursting strength were found between inflation rates of 2.5 and 5.0 ml.min-1. In conclusion, the bursting strength test is a meaningful parameter since the maximum physiological pressure equals the time of anastomotic radiological disruption, and the bursting pressure is a more exact parameter for measuring the bursting strength than the bursting wall tension.
本研究旨在评估实验性吻合口破裂强度测试的有效性。通过在测试过程中测量腔内生理压力，并对吻合的肠段进行放射学检测直至破裂，结果表明破裂压力是一个有意义的参数，因为最大压力等于吻合口漏出的时间。在术后第6天，60%的测试肠段在吻合线外破裂。这表明在术后第4至5天之后，破裂强度测试并非确定结肠吻合口强度的有效方法。此外，还评估了破裂壁张力参数。当根据注入造影剂的量确定破裂时的吻合口半径，并与放射学检测到的半径进行比较时，吻合口半径评估显示出显著差异。这些差异导致与第4天直接测量半径所确定的破裂时壁张力相比，未对测试肠段伸长进行校正时，根据注入造影剂的量确定的破裂时壁张力高61%，在对肠段伸长进行校正后，比根据注入造影剂的量确定的破裂时壁张力高36%。在2.5和5.0 ml·min-1的充气速率之间未发现破裂强度有差异。总之，破裂强度测试是一个有意义的参数，因为最大生理压力等于吻合口放射学破裂的时间，并且与破裂壁张力相比，破裂压力是测量破裂强度的更精确参数。
