大肠组织端端吻合的有限元建模与分析  

Finite element modeling and analysis on end-to-end anastomosis of the large intestine

作　　者：艾辽元 葛书晨 许晶晶[1] 李明阳[1] 毛琳[1] 宋成利[1] 

机构地区：[1]上海理工大学医疗器械与食品学院现代微创医疗器械及技术教育部工程研究中心,上海200093

出　　处：《医用生物力学》2017年第4期342-347,共6页Journal of Medical Biomechanics

基　　金：国家自然科学基金项目(81171484;51175345);中国博士后科学基金(2016M590368)

摘　　要：目的分析吻合钉成钉高度与组织损伤和吻合压力之间的关系,为医生选择合适的吻合钉钉匣及成钉高度提供理论依据和指导,提高手术的安全性。方法分析吻合钉与大肠组织交互作用,并建立大肠端端吻合的有限元模型,比较壁厚为1.0~1.5 mm的大肠组织在4种不同成钉高度时的应力分布以及径向平均应力变化。结果壁厚为1.2、1.3、1.4、1.5 mm的大肠组织,在对应成钉高度为1.0、1.1、1.2、1.5 mm时,吻合面径向平均应力分别为56.0、58.6、59.7、57.3 k Pa,与最佳吻合压力58.8 k Pa接近;最大应力出现在吻合钉与组织接触位置,其值分别为2 783、1 750、1 940、2 030 k Pa。结论吻合手术不能完全避免组织损伤,应力集中一般存在于组织与吻合钉接触的区域;将组织压缩50%~60%时成钉,吻合效果最优。Objective To analyze the relationship of closed staple height with tissue damage and compression pressure,so as to provide theoretical references and guidance for the surgeon to choose the appropriate staple cartridge and height,as well as improve the safety of operation.Methods The finite element model of stapled colorectal end-to-end anastomosis was established based on analysis of staple-tissue interaction.Large intestine tissues with different wall thicknesses（1.0-1.5 mm） were compressed by closed staples with 4 different height to compare changes in stress distributions and average radial pressure.Results When the tissues were compressed by closed staple with height of 1.0,1.1,1.2 and 1.5 mm,respectively,the average radial stress of compressed tissues with wall thicknesses of 1.2,1.3,1.4,and 1.5 mm were 56.0,58.6,59.7 and 57.3 k Pa,respectively,which was close to the optimal compression pressure.Stress concentrations were found in contact area of the staple and tissues,with the maximum stress being 2 783,1 750,1940 and 2 030 k Pa,respectively.Conclusions Tissue damage cannot be completely avoided in anastomotic surgery,and stress concentration is generally located near contact region of the staple and tissues.The optimal closed staple height ranges in 50%-60% of the uncompressed tissue height.

关 键 词：端端吻合 吻合器 组织损伤 组织压缩 有限元分析 

分 类 号：R318.01[医药卫生—生物医学工程]