肠管暂时性寄存装置在非连续性肠损伤伴失血休克犬模型中的应用  

Application of intestinal temporary storage device in canine model of discontinuous intestinal injury with hemorrhagic shock

作　　者：吴伟航 蔡志聪 林楠 杨为锦 林志雄 江传燊 张鸿文 林晨 马立强 王瑜 Wu Weihang;Cai Zhicong;Lin Nan;Yang Weijin;Lin Zhixiong;Jiang Chuanshen;Zhang Hongwen;Lin Chen;Ma Liqiang;Wang Yu(Department of General Surgery,900 Hospital of the Joint Logistics Team,Fuzhou 350025,China;Department of Gastrointestinal Surgery,Jinjiang Municipal Hospital,Quanzhou 362200,China;Department of Pediatric Surgery,Fujian Maternal and Child Health Hospital,Fuzhou 350001,China;Department of Gastroenterology,900 Hospital of the Joint Logistics Team,Fuzhou 350025,China;Department of Radiology,900 Hospital of the Joint Logistics Team,Fuzhou 350025,China;Clinical Laboratory,900 Hospital of the Joint Logistics Team,Fuzhou 350025,China)

机构地区：[1]联勤保障部队第九〇〇医院普外科,福州350025 [2]晋江市医院胃肠外科,泉州362200 [3]福建省妇幼保健院儿外科,福州350001 [4]联勤保障部队第九〇〇医院消化科,福州350025 [5]联勤保障部队第九〇〇医院放射科,福州350025 [6]联勤保障部队第九〇〇医院检验科,福州350025

出　　处：《中华实验外科杂志》2020年第11期2075-2078,共4页Chinese Journal of Experimental Surgery

基　　金：全军医学科技重点项目(CNJ15J004);全军医学科技青年培育项目(CLB18J035);全军医学科技重点项目(CNJ15J003);福建省科技厅社会发展引导性(重点)项目(2017Y0101);福建省自然科学基金(2018J01336、2017L0015)。

摘　　要：目的探讨肠管暂时性寄存装置(ITSD)在非连续性肠损伤伴失血休克犬模型中应用的可行性。方法将10只Beagle犬随机分成两组,通过离断肠管、结扎肠系膜血管及动脉放血建立犬肠多处横断伤及非连续性可疑坏死伴失血休克模型。实验组采用ITSD重建肠管,对照组则缝扎肠管,随后暂时关腹,24 h后行确定性手术。记录实验一般资料(放血量、复苏期补液量、早期处理用时、断端肠管处理时间及犬生存情况)。检测实验前、早期处理后(0 h)、2、6、12、24 h内毒素浓度,并观察肠管活力变化。实验组行消化道造影检查。取两组原可疑坏死肠组织行病理学检查。组间比较采用单因素方差分析,两两比较采用LSD-t检验。计数资料采用χ^2检验或Fisher确切概率法检验。结果两组的放血量、补液量、早期处理用时及肠管断端处理时间对比差异均无统计学意义(P>0.05)。肠管缝扎后,1只犬因误吸死亡。自术后2 h起,对照组内毒素浓度显著高于实验组[24 h:(1.217±0.324)EU/ml比(0.675±0.227)EU/ml,P<0.05]。实验组可疑坏死肠管活力变化明显优于对照组(P<0.05),肠管坏死的首发时间晚于对照组[(8.75±3.70)h比(4.63±1.87)h,P>0.05],切除的坏死肠管长度明显短于对照组[(28.30±6.76)cm比(95.68±29.31)cm,P<0.05]。消化道造影显示实验组肠管通畅性良好。对照组的肠组织病理改变较实验组严重。结论ITSD在非连续性肠损伤伴失血休克犬模型的紧急救治是安全有效的。Objective To determine the feasibility of the intestinal temporary storage device(ITSD)in non-continuous canine bowel injury with hemorrhagic shock model.Methods 10 beagle dogs were randomly divided into two groups.Beagle dogs were subjected to intestinal transections,mesenteric vessels ligation and arterial bloodletting to established canine intestinal multiple transection and non-continuous suspicious necrosis with hemorrhagic shock model.In experimental group,the broken intestine was reconstructed using ITSD,and the broken intestine in control group was ligated by suture.Then abdominal cavity was temporarily closed.The definitive surgery was performed in surviving animals after 24 h.General experimental parameters(blood loss,fluid volume within recovery period,early treatment time,the time spent in managing each resection and survival situation of dogs)were recorded.Before the experiment and 0,2,6,12,24 h after early emergency treatment,the plasma endotoxin concentration was detected.The changes of bowel changes were observed.The digestive tract radiography examination was performed in the animals in the experimental group.The prior suspicious necrotic bowel tissue in both two groups was removed for pathological examination.Results There was no statistical difference between two groups in blood loss,fluid resuscitation,early treatment time and the time spent in managing each resection(P>0.05).After the ligation of the intestines,a dog died of aspiration.From 2 h after operation,the endotoxin concentration in control group was significantly higher than that in experimental group[24 h:(1.217±0.324)EU/ml vs.(0.675±0.227)EU/ml,P<0.05].The activity changes of suspected necrotic intestine in the experimental group was significantly better than that in the control group(P<0.05).The first time of necrosis occurred in the suspected necrotic intestine in control group was earlier than that in experimental group[(4.63±1.87)h vs.(8.75±3.70)h,P>0.05].The length of excised necrotic intestine in the experimental group wa

关 键 词：损伤控制性手术 可疑性坏死 肠管缝扎 肠管重建 短肠综合征 

分 类 号：R-332[医药卫生] R826.65