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目的通过动物实验来验证袖状内翻加衬网片镶嵌式胰肠吻合术愈合的可靠性。方法 30头家猪随机分为两组,每组15头。行胰头部切除术后,分别按袖状内翻加衬网片镶嵌式胰肠吻合法(MEPI组)和传统的双层套入式胰肠吻合法(PI组)完成胰腺空肠吻合。分别于术中、术后7天、14天测定胰肠吻合口爆破压;分别于术后7天、14天切取胰肠吻合口周围组织作病理检查,并测定胶原蛋白含量。结果测定胰肠吻合口爆破压:MEPI组和PI组术中分别是(129.7±3.9)mmHg和(65.5±4.6)mmHg;术后7天分别是(184.6±9.2)mmHg和(98.4±11.2)mmHg;术后14天分别是(267.9±9.6)mmHg和(131.8±10.3)mmHg,两组比较均具有显著性的差异(P<0.01)。测定胰肠吻合口胶原蛋白含量;术后7天分别是(132.5±17.8)mg/g和(96.7±12.6)mg/g;术后14天分别是(202.3±29.8)mg/g和(168.7±22.6)mg/g,两组比较均具有显著性的差异(P<0.01)。组织病理学:MEPI组在术后7天时胰肠吻合口吻合面可见灶状增生的肉芽组织,术后14天吻合面可见较致密的结缔组织增生,胰腺断面已基本上皮化;而PI组术后7天胰腺残端断面组织坏死较严重,底部肉芽组织增生不明显,术后14天吻合面才可见肉芽组织不完全修复,胰腺残端断面少量上皮再生。结论实验研究表明,新设计的袖状内翻加衬网片镶嵌式胰肠吻合术不仅增强了吻合口缝合的牢固性,而且能加速吻合口的愈合,从而有助于降低胰漏的发生。
Objective To verify the reliability of healing of mosaic pancreaticojejunostomy with sleeve varus and lining mesh through animal experiments. Methods 30 domestic pigs were randomly divided into two groups of 15 each. Pancreatic jejunum anastomosis was performed according to the MEPI group and the traditional double-layer pancreatico-intestinal anastomosis (PI group) after the pancreatic head resection. The pressure of pancreatic and intestinal anastomotic bursting was measured intraoperatively, 7 days and 14 days after operation. Peripheral tissues of the anastomosis of the pancreas and intestine were excised for histopathology at 7 days and 14 days after operation respectively, and the collagen content was measured. Results The blast pressure of pancreaticojejunostomy was measured: (129.7 ± 3.9) mmHg and (65.5 ± 4.6) mmHg in the MEPI group and PI group respectively; and (184.6 ± 9.2) mmHg and (98.4 ± 11.2) mmHg after operation; and (267.9 ± 9.6) mmHg and (131.8 ± 10.3) mmHg respectively at 14 days after operation. There were significant differences between the two groups (P <0.01). (132.5 ± 17.8) mg / g and (96.7 ± 12.6) mg / g after 7 days and (202.3 ± 29.8) mg / g and (168.7 ± 22.6) mg / g, there was a significant difference between the two groups (P <0.01). Histopathology: MEPI group showed granulation tissue with focal hyperplastic lesions on the anastomosis surface of pancreatic and anastomosis 7 days after operation. More dense connective tissue hyperplasia was seen on the anastomosis surface 14 days after operation, and the pancreatic section was basically epithelialized. In PI group 7 days after the stump pancreatic tissue necrosis more serious necrosis, granulation tissue at the bottom of the proliferation is not obvious, 14 days after the anastomosis was incomplete granulation tissue repair, a small amount of epithelial regeneration of the stump section of the pancreas. Conclusions The experimental study shows that the newly designed sleeve inversion plus mesh mosaic pancreaticojejunostomy not only enhances the stability of anastomotic suture, but also can accelerate the healing of anastomotic, which will help reduce the occurrence of pancreatic leakage.