食管胃分层吻合法吻合口愈合质量的实验研究  

The experimental study on the healing quality of the stoma in esophagogastrostomy by layering anastomosis

作　　者：解晨昊[1] 赵雍凡[1] 寇瑛俐[1] 刘伦旭[1] 

机构地区：[1]四川大学华西医院胸心外科,成都610041

出　　处：《中华胸心血管外科杂志》2004年第5期261-263,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的　前瞻性观察食管胃分层吻合法吻合口愈合质量。方法　对 1 2只用分层吻合法吻合的实验犬 (A组 ) ,及用传统吻合方法作为对照的另 1 2只实验犬 (B组 )行吻合口大体测量、组织学观察及检测表皮生长因子 (epidermalgrowthfactor,EGF)和转化生长因子 β1 (transforminggrowthfactor β1 ,TGF β1 )表达情况。结果　A组吻合口柔软、黏膜对合好、瘢痕薄 ,炎性细胞浸润和成纤维细胞数术后早期较多(P <0 0 5 ) ,晚期 (42d)较少 (P <0 0 5 ) ;B组吻合口瘢痕厚、黏膜对合不齐、常有肌层暴露 ,早期炎性细胞浸润和成纤维细胞数较少 ,8～ 1 4d明显增加 ,晚期仍有增加趋势。细胞因子A组早期活跃 ,表达高 ,术后 4 2d仅有少量表达 ;而B组早期表达低 ,第 8d明显增加 ,第 4 2d仍有较高表达。结论　食管胃分层吻合法吻合口愈合质量高 ,其细胞增生和细胞因子表达有利于一期愈合 ;而传统吻合法的吻合口愈合缓慢 ,炎症反应贯穿全过程 ,在愈合晚期仍有较高的细胞因子表达 ,符合二期愈合。Objective To observe prespectively the healing quality in esophagogastrostomy anastomosis by layers. Methods The 12 dogs (adult male healthy hybrid dogs, group A) underwent esophagectomy with anastomosly layer. The anastomosis were observed grossly and histologic study was made on 5th, 8th, 14th, and 42th postoperative day (POD). The expression of the cytokines relating to wound healing such as epidermal growth factor(EGF), transforming growth factor β 1(TGF β 1) were detected (Immunohistochemistry, LsAB technique). Another 12 dogs underwent the intermittent whole layer with silk (group B). Results In group A, the stoma mucosa were in a better cooperation, soft, and had a thin scar. The count of the inflammation cells and fibroblast increased at the early period of postoperation (P<0 05), while decreased later (P<0 05). In group B, the stoma mucosa were in a worse cooperation, the scars were thicker, and the muscle was exposed frequently. The count of the inflammation cells and fibroblast was minimal, but they had a clear trend of increasement as time advanced. The cytokines, in group A, had a high expression and were action in the early period. There were a little expression on POD42. In group B, it had a low expression,increased clearly on POD8, and still a higher expressing level up to POD42. Conclusion The esophagogastrostomy anastomosed by layers had a high healing quality. It had the healing by first intention. In group B, the inflammation reactions run through the whole healing process. There was a higher expressing level of the cytokines in the advanced period, accorded relatively with the healing by second intention.

关 键 词：吻合口愈合 食管胃 表达 晚期 早期 实验犬 炎性细胞浸润 分层 量表 

分 类 号：R655.4[医药卫生—外科学]