带系膜去黏膜小肠片修复全层腹壁缺损可行性的初步研究  

FEASIBILITY STUDY ON REPAIRING FULL-THICKNESS ABDOMINAL WALL DEFECT WITH PEDICLED DEMUCOSAL SMALL INTESTINAL SHEET

作　　者：刘磊[1] 黎介寿[1] 周济宏[1] 顾国胜[1] 王剑[1] 

机构地区：[1]南京大学医学院临床学院(南京军区南京总医院)解放军普通外科研究所,南京210002

出　　处：《中国修复重建外科杂志》2008年第5期558-562,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：全军医学科学技术研究"十一五"计划基金资助项目(06Z017)~~

摘　　要：目的为克服人工材料在腹壁缺损修复中的缺点,设计以动物自体带系膜去黏膜小肠片修复腹壁缺损的实验研究。方法健康普通雌性家猪25头。取20头行一般观察,随机分为空肠组和回肠组,每组10头。切除10cm×7cm皮肤至腹膜的腹壁组织制备全层腹壁缺损模型,分别以自体带系膜去黏膜空肠、回肠片修复腹壁缺损,再行一期断层皮片移植覆盖。术后30d观察两组动物一般情况,并在体检测修复腹壁的抗张强度。另5头同法制备全层腹壁缺损模型,以中段小肠的带系膜去黏膜小肠片修复腹壁缺损,再行一期断层皮片移植覆盖。术后30d整块切取修复腹壁,观察修复腹壁缺损前后带系膜去黏膜小肠片、断层皮片及修复腹壁的组织学变化,测量各部分组织的相对厚度。结果动物手术均成功。带系膜去黏膜空肠、回肠片与剩余腹壁边缘均Ⅰ期愈合,无感染及裂开。术后无肠梗阻及肠吻合口瘘发生。断层皮片移植均成活,移植皮片与缺损腹壁边缘缝合处均有可自行愈合的局灶性坏死。空肠组2头动物及回肠组1头动物出现移植皮片引流戳孔处肠黏膜组织再生,经再次刮除黏膜组织并将移植皮片戳孔缝合后愈合。自由活动状态下腹壁外观正常,无复发性疝形成。在体检测修复腹壁抗疝形成的抗张强度空肠组和回肠组分别为(24.8±3.4)kPa和(21.3±2.8)kPa,二者差异有统计学意义(P<0.01),两组修复腹壁均可承受40kPa腹腔内压力。修复腹壁缺损前,带系膜去黏膜小肠片表面有少量黏膜层组织残留,修复腹壁缺损后30d,修复腹壁各部分组织均有明显增生、增厚,原去黏膜小肠片表面残留的黏膜层组织完全消失。结论带系膜去黏膜小肠片修复全层腹壁缺损操作简便,成功率高,无重要并发症,修复效果好,修复腹壁抗张强度高,无需使用假体材料,具有较高的可行性。Objective To overcome the disadvantages of the artificial materials, to design pedicled demucosal small intestinal sheet to repair full-thickness abdominal wall defect. Methods The porcine model of full-thickness abdominal wall defect by resecting 10 cm × 7 cm abdominal wall tissue （from skin to peritoneum） in 20 female animals, which were randomized to jejunum and ileum sheet groups（n=10）. Defect of abdominal wall were repaired with pedicled demucosal jejunum/ileum sheet respectively and immediate split-thickness free skin grafting. The general condition was observed and the tension strength of the repaired abdominal wall was measured 30 days postoperatively. In another 5 models, defect was repaired with pedicled demucosal small intestinal sheets and immediate split-thickness free skin grafting. The histological change and tissue thickness of the pedicled demucosal small intestinal sheet, split-thickness free skin graft and the repaired abdominal wall were observed and measured respectively after 30 days of operation. Results The operations were successful and no operative death occurred in all animals. All pedicled demucosal small intestinal sheets primarily healed to the edge of defected abdominal walls. Neither infection nor wound dehiscence occurred. All the split-thickness free skin grafting were successful. Regeneration of the intestinal mucosa occurred 4 days to 5 days postoperatively in 3 animals （2 of jejunum sheet group and 1 of ileum sheet group） at the initial stage and were successfully treated. No postoperative herniation occurred in all animals. The celiac pressure of herniation of the repaired abdominal wall jejunum/ileum sheet was （24.8 ±3.4） kPa in jejunum sheet group and （21.3 ± 2.8） kPa in ileum sheet group, and the difference was significant （P 〈 0.01）. No rupture of the repaired abdominal wall occurred in jejunum and ileum sheet groups when the celiac pressure was 40 kPa. Before repairing the abdominal wall defects, there was a little residual mucosal tissue on

关 键 词：腹壁缺损 去黏膜小肠片 修复 猪 

分 类 号：R656.3[医药卫生—外科学]