贯穿式胰管空肠黏膜吻合的动物实验研究

发布时间：2018-05-27 08:09

本文选题：胰肠吻合术 + 胰瘘　；参考：《皖南医学院》2016年硕士论文

【摘要】：目的:通过与胰腺空肠端侧吻合的比较,探讨贯穿式胰管空肠黏膜吻合的可行性及安全性。方法:采用家猪建立胰肠吻合的手术模型,将实验猪随机分为实验组和对照组,实验组8头,对照组6头,实验组采用贯穿式胰管空肠黏膜吻合,对照组采用胰腺空肠端侧吻合。术前测实验猪体重,检测空腹血糖、血清淀粉酶含量。术中观察胰腺质地、形状、胰管直径等情况,记录术中吻合时间,并行吻合口测压;术后三天测引流管中引流液的淀粉酶含量,观察引流量及性质;术后注意观察猪的精神状态,进食情况、排便时间及大便性状等;术后一周再次手术,观察术中腹腔粘连情况,吻合口是否牢靠,周围有无积液、积脓;取出吻合口,记录手术时间,观察大体及病理变化,对比研究贯穿式胰管空肠黏膜吻合的临床应用价值。结果:两组吻合方式在术前体重、血糖、血清淀粉酶、胰管直径、胰腺质地、无统计学差异(P0.05),术中观察胰腺质地软而脆,胰腺显淡粉红色,胰管直径细,胰管直径实验组为:1.15±0.21mm,对照组为1.16±0.18mm(t=0.155,P=0.879),P0.05,差异无统计学意义,具有可比性。两组术中胰肠吻合时间:实验组为15.13±3.44min,对照组为23.33±3.44min(t=4.415,P=0.001),P0.05,差异有统计学意义;术后实验组一只家猪未醒死亡,尸检探查吻合口周围未见明显渗液,考虑可能由于麻醉过量引起死亡;对照组一只家猪术后第三天死亡,尸检可见腹腔大量积液,吻合口周围有渗出,伴脓臭味,腹腔淀粉酶检测值明显升高,考虑术后胰瘘引起的感染性休克死亡。两组术后胰瘘发生率:实验组为0(0/7),对照组为33.33%(2/6),其中一例为B级胰瘘,一例为C级胰瘘;两组家猪术后进食时间:实验组为50.71±11.92h,对照组为83.4±12.23h(t=4.810,P=0.001),P0.05,差异有统计学意义;两组七天后二次手术术中可见对照组腹腔黏连明显较实验组重,分离黏连耗时较长,寻找吻合口困难,第二次手术时间为:实验组为97.6±16.37min,对照组为128.6±17.67min(t=3.135,P=0.011),P0.05,差异有统计学意义。实验组吻合口大体形态完整,周围无明显渗出积液,空肠壁及胰腺无充血、水肿,吻合口愈合良好(见图1)。对照组吻合口大体形态完整,周围少量渗出积液,空肠壁充血、水肿,胰腺炎症较重(见图2)。吻合口病理实验组可见胰腺及空肠壁形态完整,固定可靠,胰腺及空肠壁见可见少量炎症细胞及多量成纤维细胞;对照组可见胰腺断端与空肠壁连接疏松,胰腺残端及空肠壁周围充满多量炎症细胞,部分胰腺组织可见坏死。结论:贯穿式胰管空肠黏膜吻合是一种较为简单、有效的胰肠吻合方式,值得临床上推广。
[Abstract]:Objective: to investigate the feasibility and safety of perforating jejunal mucosal anastomosis with pancreatic jejunal end-to-side anastomosis. Methods: a model of pancreaticojejunostomy was established in domestic pigs. The pigs were randomly divided into experimental group (n = 8) and control group (n = 6). The control group was treated with pancreatic jejunum end-to-side anastomosis. The body weight, fasting blood glucose and serum amylase were measured before operation. Pancreatic texture, shape, diameter of pancreatic duct were observed during operation, anastomosis time was recorded, anastomotic stoma pressure was measured, amylase content of drainage fluid in drainage tube was measured three days after operation, drainage flow rate and properties were observed. Pay attention to observe the mental state, feeding condition, defecation time and defecation character of the pig after operation, reoperate one week after operation, observe intraperitoneal adhesion during the operation, whether the anastomosis is firm or not, whether there is effusion around, accumulate pus, and take out the anastomotic stoma, The operative time, gross and pathological changes were recorded, and the clinical value of perforating jejunal mucosal anastomosis was compared. Results: there was no significant difference in preoperative body weight, blood glucose, serum amylase, pancreatic duct diameter, pancreatic texture between the two groups (P 0.05). During the operation, the pancreas was soft and brittle, the pancreas was light pink, and the diameter of pancreatic duct was fine. The diameter of pancreatic duct was 1.16 卤0.18 卤0.21 mm in the experimental group and 1.16 卤0.18 mm in the control group. The difference was not statistically significant and comparable. The operative time of pancreaticojejunostomy was 15.13 卤3.44 min in the experimental group and 23.33 卤3.44 min in the control group (P 0.05). In the control group, a domestic pig died on the third day after operation. A large amount of fluid was found in the abdominal cavity at autopsy. There was exudation around the anastomotic stoma, and the amylase detection value in the abdominal cavity was obviously increased. The septic shock caused by pancreatic fistula after operation was taken into account in the death of septic shock. The incidence of postoperative pancreatic fistula was 0 / 7 in the experimental group and 33.33 / 2 / 6 in the control group, one of them was grade B pancreatic fistula and the other was grade C pancreatic fistula, the feeding time of the two groups was 50.71 卤11.92 h in the experimental group and 83.4 卤12.23 h in the control group (P 0.05). After the second operation seven days later in the two groups, the abdominal adhesion in the control group was significantly heavier than that in the experimental group, and the separation time was longer and the anastomotic site was difficult to find. The second operation time was 97.6 卤16.37 min in the experimental group and 128.6 卤17.67 min in the control group, and the difference was statistically significant. In the experimental group, the anastomotic stoma was generally intact, there was no effusion around it, no congestion and edema in the wall of the jejunum and pancreas, and the anastomotic site healed well (see figure 1). In the control group, the anastomotic stoma was generally intact, with a small amount of effusion, congestion, edema and severe pancreatitis (see Fig. 2). In the experimental group, the morphology of pancreas and jejunum wall was intact, the fixation was reliable, a small number of inflammatory cells and multiple fibroblasts were found in pancreas and jejunum wall, and in the control group, loose connection between the broken end of pancreas and the jejunum wall was observed. Pancreatic stump and jejunum wall were filled with inflammatory cells and necrosis was observed in some pancreatic tissues. Conclusion: perforated jejunostomy is a simple and effective pancreaticojejunostomy, which is worth popularizing in clinic.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R656

【参考文献】