论文部分内容阅读
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。
Objective To compare the effects of three methods of traditional anastomosis, laser welding alone and laser assisted with polylactic acid-degradable stent. Methods Sixty Sprague-Dawley rats were divided into three groups: suture group, laser group and laser scaffold (biodegradable group), 20 in each group. (1) suture group: conventional suture 9 to 10 stitches. (2) Laser group: 3-gauge equidistant sutures on the welding surface were used for traction and fixation of intestines. The laser output power was 0.15 W, pulse time was 0.2 s, interval was 0.8 s and the vertical distance from laser to anastomosis was 0.8 ~ 1.0 cm. (3) laser stent group: welding 3-needle equidistant suture to traction fixation intestine, the intestine into polylactic acid degradable stent, the rest with the laser group. The operation time, anastomotic adhesions, stenosis and rupture pressure were measured at 7 days after operation. At the same time observe the anastomotic histopathological changes. RESULTS: The anastomosis time was 26.2 ± 7.3 min in the suture group, 19.5 ± 6.3 min in the laser group and 22.3 ± 6.8 min in the laser stent group. There was a significant difference between the three groups (P <0.05). (2) The degree of adhesion in each group was graded according to the Sertz’s score: the average values of adhesion in the suture group, laser group and laser stent group were 1.4, 0.9 and 0.8 respectively, the difference was significant. (3) Stenosis index: The stenosis index of suture group was (8.6 ± 1.5), while the stenosis index of laser group (7.8 ± 1.6) and stenosis index of laser bracket group (7.6 ± 1.8) Significance (P> 0.05). (4) The rupture pressure was measured: (185.4 ± 20.3) mm Hg at 7 days after operation, and (160.6 ± 24.5) mm Hg in laser group and 217.5 ± 25.4 mm Hg in laser group Of burst pressure was significantly better than the suture group and the laser group (P <0.05, P <0.001). The burst pressure of the laser group was lower than that of the suture group (P <0.05). (5) pathological changes: laser welding group and laser group anastomotic reaction around the foreign body light, smooth wall; suture group visible foreign body reaction, the wall is not smooth. Conclusions It is safe and feasible that CO2 laser welding combined with biodegradable stent for bowel anastomosis is superior to simple suture and CO2 laser welding.