【摘要】 目的比较传统缝合、单纯激光焊接、激光辅以聚乳酸可降解支架三种方法肠管吻合的效果。方法将60只SD大鼠分为三组,缝合组、激光组、激光支架(可降解)组,每组各20只。(1)缝合组:常规丝线缝合9~10针。(2)激光组:焊接面3针等距缝线以牵引固定肠管,激光输出功率为0.15 W,脉冲时间0.2 s,间隔0.8 s,激光到吻合口的垂直距离0.8~1.0 cm。(3)激光支架组:焊接面3针等距缝线以牵引固定肠管后,肠管内放入聚乳酸可降解支架,其余同激光组。测定各组手术时间、术后7 d吻合口粘连、狭窄程度及破裂压。同时观察吻合口组织病理学变化。结果 (1)吻合时间:缝合组(26.2±7.3)min,激光组(19.5±6.3)min,激光支架组(22.3±6.8)min。吻合时间三组间有差异(P<0.05)。(2)各组粘连程度根据Sertz’s评分标准分级:缝合组、激光组和激光支架组的粘连均值分别为1.4、0.9和0.8,差异有显著意义。(3)狭窄指数:缝合组的狭窄指数为(8.6±1.5),而激光组的狭窄指数为(7.8±1.6),激光支架组的狭窄指数为(7.6±1.8),各组间差异无显著意义(P>0.05)。(4)破裂压测定:术后7 d破裂压缝合组为(185.4±20.3)mm Hg,激光组为(160.6±24.5)mm Hg,激光支架组为(217.5±25.4)mm Hg,激光支架组的破裂压明显优于缝合组和激光组(P<0.05,P<0.001)。激光组术后破裂压低于缝合组(P<0.05)。(5)病理学改变:激光焊接组和激光组吻合口周围异物反应轻,管壁光滑;缝合组可见明显的异物反应,管壁不光滑。结论 CO2激光焊接辅以可降解支架进行肠管吻合是安全、可行的,其效果优于单纯缝合及CO2激光焊接。更多还原

【Abstract】 Objective To compare traditional suturing,simple laser welding and combined application of laser and biodegradable polylactic acid stents,and to explore the characteristics and the feasibility of these three methods.Methods Totally 60 SD rats were divided into three groups: the traditional suture group,simple laser group and laser plus biodegradable stent group( n = 20). After the intramuscular anesthesia of 10% chloral hydrate at 0. 5 mg / kg,each SD rat had an intestinal anastomotic cut from the ileocecal ileum 10 cm to 1. 5 cm ileum. In the simple laser group,the 3 equidistant sutures fixing the traction intestine were removed after the welding. In the laser plus biodegradable stent group,the stent was implanted first. In the traditional sutures group,3-0 silk sutures were used. The operation time of each group was measured respectively. Anastomotic adhesions,stenosis and fracture pressure were measured at Day 7 after the operation. The pathological changes of each group were observed.Results The anastomosis times of the suture group,simple laser group and laser plus stent group were( 26. 2 ± 7. 3) min,( 19. 5 ±6. 3) min,and( 22. 3 ± 6. 8) min respectively. Both the difference between the laser group and suture group and that between the laser plus stent group and suture group were significant( P < 0. 05). With Sertz’s Standard Rating System,the adhesion means of the suture group,laser group and laser plus stent group were 1. 4,0. 9 and 0. 8 respectively,and the difference was significant. The stenosis indexes of the structure group,laser group and laser plus stent group were( 8. 6 ± 1. 5),( 7. 8 ± 1. 6) and( 7. 6 ± 1. 8) respectively,indicating no significant difference( P > 0. 05). The rupture pressure of the structure group,laser group and laser plus stent group were( 185. 4 ± 20. 3) mm Hg,( 160. 6 ± 24. 5) mm Hg and( 217. 5 ± 25. 4) mm Hg,and the rupture pressure of the laser plus stent group was remarkably higher than that of other two groups( P < 0. 05,P < 0. 001). As to pathological changes,while the foreign body reactions around the stoma being light and the wall being smooth in the laser plus stent group and laser group,obvious foreign body reactions occurred in the suture group and the wall was not smooth.Conclusions The combination of CO2 laser welding and biodegradable stent is a safe and feasible method for intestinal anastomosis,and the effect is better than that of traditional suturing and sole CO2 laser welding.更多还原