Popović M R
Institut za bolesti digestivnog sistema KCS I hirurska klinika za digestivnu hirurgiju, Beograd.
Acta Chir Iugosl. 1994;41(2 Suppl 2):239-42.
The particularities of the surgical suture of duodenum and small intestine are exposed. According to the recent experiences from the literature, the best material for the intestinal suture is monofilamentous, with delayed resorption rate, and characterized by the hardness appropriate to the tissue involved. The representatives of these are Polyglactin and Polydioxanon. In the technique of the duodenal suture, inversion of the tissue and placing the sutures in the healthy tissue are more important than mucosal inversion and multiple layers closure. The omental patch must be variable, and not involved directly in sutures. In the small intestinal surgery, one layer sero muscular-extramucosal, or two layers mucomucosal with inversion and seroserosal suture are to be used. For duodenojejunal transition, terminolateral anastomosis is recommendable. Upon lower parts of ileum oblique terminoterminal or latero-lateral anastomosis is to be used. In the cases of luminal disproportion between open ends, terminolateral anastomosis seems to be the best choice. The percentage of duodenal stump dehiscence in the period of 1986-1992. is 2.53% upon 356 emergencies of delayed operations, and the percentage of the intestinal anastomotic dehiscence upon 102 elective and emergency operations is 5.8%.
十二指肠和小肠手术缝合的特殊性已被揭示。根据文献中的最新经验,肠道缝合的最佳材料是单丝的,吸收延迟,其硬度适合所涉及的组织。这些材料的代表是聚乙交酯和聚二氧六环酮。在十二指肠缝合技术中,组织内翻以及将缝线置于健康组织中比黏膜内翻和多层缝合更为重要。网膜补片必须可变,且不直接参与缝合。在小肠手术中,可采用一层浆肌层-黏膜外缝合,或两层黏膜对黏膜内翻加浆膜对浆膜缝合。对于十二指肠空肠交界处,建议采用端侧吻合术。在回肠下部,应采用斜端端吻合术或侧侧吻合术。在断端管腔不均衡的情况下,端侧吻合术似乎是最佳选择。1986 - 1992年期间,356例延迟手术急诊中十二指肠残端裂开的发生率为2.53%,102例择期和急诊手术中肠吻合口裂开的发生率为5.8%。