幼兔胆囊空肠Roux—en—Y吻合术Roux支实验研究  

Experiment research of Roux jejunum for hepatoenterostomy in juvenile rabbits

作　　者：李胜利 张阔[2] 张军[3] 明安晓[3] 侯文英[3] 魏延栋[3] 葛军涛[3] 王海滨[3] 李龙[3] 

机构地区：[1]内蒙古自治区人民医院肝胆胰外科,呼和浩特010017 [2]北京大学医学部 [3]首都儿科研究所外科

出　　处：《中华小儿外科杂志》2013年第7期529-533,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨探索小儿胆肠吻合术中Roux支长度与临床效果之间的关系。方法45只1月龄体重（600±60）g清洁级新西兰幼兔按随机数字表法分为：短Roux支组（SRJG）；长Roux支组（LRJG）；空白对照组（CG）。记录围手术期并发症、术后活动性和反应性。记录、计算平均手术时间、平均肠鸣音恢复时间、平均觅食水时间和生存率。测量、计算术前、术后2周、1个月、3个月实验各组幼兔的平均头围、平均身长和平均体重。解剖死亡幼兔，查找死因并记录。分析不同袢空肠组（Rouxjejunumgroup，RJG）并发症、成功率、对幼兔胃肠道和生长发育的影响。结果尉G间平均手术时间差异无统计学意义；RJG间平均肠鸣音恢复时间和平均觅食水时间差异无统计学意义，但比CG较明显延长；三组反应性和术后活动性差异无统计学意义。生存率：SRJG93．34％，LRJG66．67％；死因主要为Roux支和呼吸道并发症。术后开腹发现：S尉G肠粘连2例，无Roux支扭转；LRJG肠粘连8例，Roux支扭转6例；RJGRoux支平均增长（2．2±0．25）cm／月；CG幼兔无腹腔粘连，空肠平均增长（2．3±0．33）cm／月。RJG1个月Roux支空肠平均管径（0．63±0．07）cm，与CG（0．8±0．05）cm差异无统计学意义，而3个月Roux支空肠平均管径（O．35±0．08）cm较CG（0．8±0．05）cm明显缩小。术前三组平均头围、平均身长和平均体重差异无统计学意义；术后2周RJG比CG降低，差异有统计学意义，而尉G之间无明显差异；术后1个月和3个月LRJG低于SRJG和CG，但后两组差异无统计学意义。术后3个月上消化道造影及造影后开腹发现：LRJG和SRJG幼兔均无反流。结论SRJG并发症少术后恢复快，因而小儿胆肠吻合术中短的个体化的Roux支空肠可能并发症较少，更利于小儿术后恢复和生长发育。Objective To explore the relationship between clinical results and the length of Roux jejunum for Roux-en-y hepatoenterostomy in juvenile rabbits. Methods Forty-five New Zealand juvenile rabbits were randomly divided into 3 groups., short roux jejunum group （SRJG, n = 15）, long roux jejunum group （LRJG, n = 15） and control group （CG, n = 15）. During operation, medial operating time （MOT） and perioperative complications （PC） were recorded. After operation, sensitivity evaluation （SE）, mobility evaluation （ME）, medial bowel sound time （MBST） and medial seeking water and food time （MSWFT） of the rabbits were recorded. Survive rate （SR） of three groups and effects on growth and development of juvenile rabbits were compared and analyzed. Results There was no significant difference of MOT between SRJG and LRJG group. MBST and MSWFT were also no significant difference between RJGs but were significant longer in RJGs than those in CG. SE and ME were the same in RJG as those in CG. SR was 93. 34% in SRJG and 66. 67~ in LRJG. The causes for death were complications of air way and Roux jejunum. Intestinal adhesion was fewer in SRJG and in CG than that in LRJG under laparotomy observation. Roux jejunum volvulus was not detected in SRJG but occurred in 6 cases of LRJG. The growth length of Roux jejunum was 2. 2 ± 0. 25 cm monthly in RIG and 2. 3 ± 0. 33 cm monthly in CG. The medial diameter of Roux jejunum was 0. 63 ± 0. 07 cm in RJG and 0. 8 ± 0. 05 em in CG in the 1st Post-op month, while it was 0. 35 ± 0. 05 cm in RJG in the 3rd Post-op month, which was deceased significantly. MHC, MBL and MW showed no significant difference before operation and were decreased in RJG in the 2nd Post-op week and were decreased in LRJG in the 1st and the 3rd Post-op month.. Upper gastrointestinal contrast and laparotomy observation in the 3rd Post-op month, no reverse flow in Roux jejunum was noted. Conclusions SRJ is the fittest Roux jejunum for Roux-en-y hepatoenterostomy in juvenile rabbits. Sh

关 键 词：吻合术 Roux-en-Y 手术后并发症 兔 

分 类 号：R726[医药卫生—儿科]