小肠单层吻合术后肠管愈合的实验研究  

HEALING OF INTESTINAL SINGLE - LAYER ANASTOMOSIS

作　　者：刁美[1] 李龙[1] 张金哲[1] 陈晋杰[1] 董瑞安[1] 

机构地区：[1]北京儿童医院普外科,100045

出　　处：《现代手术学杂志》1998年第3期194-199,共6页

摘　　要：本文研究单层吻合术对肠管愈合的可靠性。笔者用Wistar鼠24只,提取一段小肠分别行单、双层吻合术。动物随机分6组,分别于术后1～6天测吻合口破裂压力,取标本行光镜及电镜观察,结果动物全部存活。术后4日单、又层吻合口抗破裂压力最低,分别为:108.70±32.6mmHg,109.30±48.8mmHg;术后6日单、双层吻合口抗破裂压力最高,分别为:227.20±40.1mmHg,201.50±22.9mmHg。电镜下见,单层吻合口粘膜层于术后3日开始对合愈合。光镜下见,其肠壁各层对合良好,粘膜上皮细胞向对侧爬行;术后5日大量纤维充填吻合口。电镜下见,双层吻合口粘膜层于术后4日开始愈合。光镜下见,其肠壁各层对合不良,间距大;术后6日大量纤维充填吻合口。笔者认为,单层吻合与双层吻合比较,各层组织对合好,有利于吻合口间隙纤维母细胞充填,粘膜愈合快,且4日内二者吻合口抗破裂压力相同。Object: to evaluate the healing reliability of small intestinal single - layer anastomosis. Materials and methods: single - layer closure and two - layer closure were respectively performed on an intestinal segment of 24 Wistar rats which were divided into 6 groups. The rupture pressures of anastomosis were measured on day 1 through day 6 postoperatively. The specimens were studied histologically. Results:all rats survived. The lowest rupture pressure of single - layer anastomosis and two - layer anastomosis were 108. 70 ± 32. 6mmHg and 109. 30±48. 8mmHg respectively on the fourth postoperative day, and the highest rupture pressure were 227.20 ± 40. 1mmHg and 201. 50 ± 22. 9mmHg respectively on the sixth day. Under the electron microscope, the mucosa of single layer closure began to healoine on the third day; under the light microscope, it was shown that each layer of the intestinal wall was well coapted, the epithelial cells sealed the anastomosis line on the third day, vast amount of fibroblasts filled in the anastomotic stoma on the fifth day. Under the electron microscope, the mucosa of two - layer closure began to heal on the fourth day; under the light microscope, a wider gap existed between the two ends, vast amount of, fibroblasts filled in on the sixth day. Conclusion: the study suggests that single- layer anastomosis for small intestine is as reliable as two - layer anastomosis. However, the coaptation of bowel layers in single - layer anastomosis is better than that in two - layer anastomosis.

关 键 词：小肠手术 单层吻合术 肠管愈合术 肠端 吻合方法 

分 类 号：R656.7[医药卫生—外科学]