不同后送时间对新西兰兔肠管濒海战创伤Ⅰ期确定性手术的影响  

Effects of different evacuation time on primary definitive operation in intestinal littoral wound of New Zealand rabbit

作　　者：王冰[1] 李迪[2] 高建[3] 张再重[1] 林孝文[2] 唐玉娟[2] 王瑜[1] 王烈[1] 

机构地区：[1]南京军区福州总医院普通外科,福建福州350025 [2]福建医科大学总院临床学院,福建福州350025 [3]福建中医药大学,福建福州350108

出　　处：《中国现代普通外科进展》2016年第11期841-844,849,共5页Chinese Journal of Current Advances in General Surgery

基　　金：南京军区医学科技创新项目(2013ZX;2014ZX25)

摘　　要：目的 :建立新西兰兔肠管濒海战创伤模型,研究不同后送时间对Ⅰ期确定性手术的影响。方法 :30只新西兰兔随机分为A、B、C 3组,各组动物麻醉并固定后,均在海水浸泡状态下以预热型实验用气步枪(专利号:ZL201420403237.X)正面射击腹部反麦氏点,10 min后打捞,A组直接手术,B组、C组分别于陆地观察20 min(伤后0.5 h)、50 min(伤后1 h)模拟后送时间,再行手术,手术方式均选用Ⅰ期确定性手术。比较各组术后10 d的存活情况,并于术后第7天、第14天从各组随机抽取2只新西兰兔进行剖腹探查,评估吻合口愈合情况。结果:术后10 d A组存活10只(100%),B组存活9只(90%),C组存活6只(60%),A组与B组存活情况差异无统计学意义(P>0.05),A组与C组、B组与C组存活情况差异有统计学意义(P<0.05)。死亡新西兰兔经尸检明确死亡原因主要为吻合口瘘和腹腔脓肿。术后吻合口愈合情况评分:术后7 d A组0.8±0.4、B组1.2±0.2、C组2.6±0.5;术后14 d A组0.2±0.4、B组0.6±0.5、C组3.2±0.4。吻合口愈合情况A组优于B组和C组(P<0.05)。结论:随着后送时间延长,肠管濒海战创伤Ⅰ期确定性手术术后并发症风险增加。Objective： To research the effects of different evacuation time on primary definitive operation through the models of the intestinal littoral wound in New Zealand rabbit. Methods： 30 New Zealand rabbits were randomly divided into three groups： A, B, C. After anaesthetized and fixed, animals in sea-water were shot at the reverse mcburney point by the air gun. Salvaged after 10min, animals of A group were operated directly, while animals of B group and C group were observed on land respectively after 20 minutes and 50 minutes to simulate evacuation time before operation. All of the surgical methods were selected primary definitive operation. The each group＇s survival rate at 10-day after operation was observed and compared as well as finally survival rate. Besides, respectively after 7-day and 14-day, two animals randomly selected from each group underwent exploratory laparotomy, and the anastomotic healing was evaluated. Results： The survival rate at 10-day after operation of A group was 100%, of B group was 90%, and of C group was 60%,the difference was statistical significant （P〈0.05）. Through the autopsy, the main causes of death were anastomotic leakage and abdominal abscess. The postoperative anastomotic healing of A group was better than B group and that of B group was better than C group （P〈0.05）. Conclusion： With the prolonged of evacuation time, the complication＇s risk of primary definitive operation in intestinal littoral wound.

关 键 词：肠管濒海战创伤 后送时间 手术 兔 

分 类 号：R826.5[医药卫生—临床医学]