套入式胰肠吻合口创伤愈合的实验观察.docVIP

精品论文 参考文献 套入式胰肠吻合口创伤愈合的实验观察 黄石市爱康医院 湖北黄石 435000 【摘 要】目的：通过观察胰肠吻合口创伤愈合的基本过程，为胰肠吻合术式的改进和胰瘘发生机制的探讨提供理论依据。方法：10只家猪均行套入式胰肠端端吻合术。术后观察一般情况；分别在术后第3、7d检测腹腔引流液淀粉酶量；分别在术后第3、7、14、30d完整切下吻合处标本做病理检查。结果：（1）一般情况：实验期间无死亡。（2）腹腔引流液淀粉酶定量：本组10例术后第3天均在正常范围内；术后第7天9例在正常范围内，1例为3217IU/L，明显高于正常。（3）组织病理学：吻合口为瘢痕愈合，瘢痕厚，早期组织坏死脱落明显，炎性细胞侵润和成纤维细胞较少，714天炎性细胞明显增加，晚期仍存在；胰腺断面坏死及炎性渗出严重，慢性炎性反应持续存在，1430天逐渐由黏膜上皮覆盖。结论：套入式胰肠吻合术后胰肠吻合口愈合缓慢，炎症反应贯穿全过程，符合二期愈合。肠液的刺激作用和胰腺与空肠为不同的组织是影响胰肠吻合口愈合的两个因素。 【关键词】创伤愈合；胰管空肠吻合术；吻合口；病理学 【中图分类号】R656.6+4 【文献标识码】B 【文章编号】1674-8999（2015）9-0975-02 【Abstract】Objective：To improve the technique of pancreaticojejunal anastomosis and to study the mechanism of pancreatic fistula after pancreaticojejunostomy, the experimental study about the wound healing after end-to-end pancreaticojejunal invagination was performed on piglets. Methods：The ten piglets underwent end-to-end pancreaticojejunal invagination. The general status were observed， the quantity of amylase in abdominal fluid were assessed on the postoperative day3 and 7，and histopathological findings were recorded on postoperative day 3，7，14 and 30. Results：No death happened; The quantity of amylase in abdominal fluid was normal in 9 piglets and was 3217 IU/L in 1 piglet on postoperative day 7. The anastomotic site repaired by scar tissue，the stoma mucosa had a thick scar. The necrosis and shedding happend evidently. The count of the inflammation cells and fibroblast was minimal and rised higher as time advanced. The inflammation reactions in the remained pancreas were evident until postoperative day 14，then was covered by mucosal epithelium step by step. Conclusions：The inflammation reactions run through the whole healing process，which accorded relatively with the healing by second intention，the stimulating effect of enteral juice and the different histologic feature are two factors associated with the anastomotic healing.. 【Key Words】Wound healing，Pancreaticojejunostomy，Stomas，Pathology 胰十二指肠切除术（PD）自1898年Cod