ObjectiveTo evaluate the efficacy of XiaochengqiMixture (XM) on promoting healing of colonic stoma. MethodsForty Wistar rats were divided into two groups randomly after colonectomy: experimental group (n=20) and control group (n=20). In early postoperatively stage rats were given gastric administration of XM in the experimental group and pure water in the control group. On day 3, 7, and 14 after establishment of animal models, laparotomy was performed in two groups of rats, respectively. Anastomotic stoma and surrounding tissues were harvested to detect the context of hydroxyproline and collagen fiber proportion by Masson dying. ResultsOn day 3 after establishment of animal models, hyperplastic collagen with small fiber was observed while no fasciculus was found. Hydroxyproline context and collagen fiber proportion of rats were higher in experimental group than those in control group (Plt;0.05). On day 7 after operation, many fasciculuses were found in two groups of rats, hydroxyproline context and collagen fiber proportion of rats were higher in experimental group than those in control group (Plt;0.01). On day 14 after operation, fasciculuses became bigger and more regular in arrangement, but there was no significant difference between the two groups (Pgt;0.05). ConclusionXM is capable of promoting healing of colonic stoma and might prevent the occurrence of anastomotic fistula.
In this study, the effect of neostigmine on the healing of colonic anastomoses has been investigated following onestage resection and anastomosis for complete leftsided colomic obstruction.It was found that neostingmine promoted colonic anastomotic healing either experimentally or clinically. Further, the authors discuss the pathogenesis of anastomotic leakage but suggest that neostigmine should be used in the first 5 hours after operation.
目的 探讨直肠癌双吻合器保肛术后预防吻合口漏的措施。方法 回顾性分析2006年1月至2009年7月期间在我院行Dixon术的358例直肠癌患者的临床资料。结果 本组病例均一次吻合成功,术后出现吻合口漏30例（8.4%），多发生在术后5~10 d,均经非手术综合性措施治疗后漏口愈合,愈合时间14~60 d,中位时间37 d。结论 术前一般状况调整、术中严密操作、正确的引流管放置与灌洗引流、营养支持等综合性措施对低位直肠癌Dixon术后吻合口漏的防治效果较好。
目的 探讨直肠癌前切除术吻合口漏的原因及对策。方法 对符合行直肠前切除术的73例直肠癌患者行全直肠系膜切除术,用双吻合器技术（double-stapling technique,DST）吻合结直肠。2004年1月以后收治的病例特别注意了会阴助推、 远侧直肠密闭试验、吻合器穿刺头穿刺点的选择、吻合口漏气试验和经肛门至结肠及经腹壁至吻合口旁放置引流管的技术细节。结果 全组2例(2.74%)发生吻合口漏，均为2004年1月以前的病例，1例经横结肠造瘘治愈，另1例经引流管冲洗治疗治愈； 2004年1月以后的65例无吻合口漏发生。结论 注意直肠癌前切除术中的一些技术细节， 可在一定程度上降低全直肠系膜切除条件下DST吻合的吻合口漏发生率。
【Abstract】ObjectiveTo study the positive effect of recombinant human epidermal growth factor (rhEGF) on rabbit intestinal anastomotic wound healing after bowel resection. MethodsFortyeight white rabbits were randomly divided into study group in which rhEGF was injected and spinged in the submucosa and mucosa respectively during intestinal anastomosis after bowel resection, and control group in which only intestinal resection and anastomosis was performed. The leukocyte was counted. The incidence of anastomotic leakage and the synthesis of collagen fibrils and hydroxyproline were observed. ResultsThe leukocyte numbers in the anastomotic tissue in two groups rabbits increased slightly 3 d, 5 d and 7d after intestinal anastomosis, but the difference between study group and control group was insignificant (Pgt;0.05). The incidence of anastomotic leakage in the control group (16.7%) was higher than that of the study group (4.3%). The area of collagen fibrils 3 d, 5 d and 7d after intestinal anastomosis in the study group were significantly more than that in the control group (P＜0.05). Number of fibroblast was higher in the study group and the cells appeared bigger nucleus and dense colouration as well as enriched plasm. Angiogenesis in anastomosis tissue in the study group was significant and normal structure was present. Cell structure of anastomosis mucosa was damaged in the control group. Synthesis of hydroxyproline in anastomotic tissue 5 d and 7 d after anastomosis in the study group was more than that in the control group (P＜0.05).ConclusionInflammation was present in the whole process of wound healing, and local using of EGF had insignificant effect on system inflammation. EGF functions as chemoattractant and increases the recruitment of leukocytes, monocytes and fibroblasts into the wound area. EGF increases the production of collagen, angiogenesis and the synthesis of hydroxyproline. So EGF could promote wound healing and protect from anastomosis leakage in this study.
目的 探讨盲肠管道式造口持续减压方法防治直肠癌低位前切除术后吻合口漏的临床价值。方法 选择120例拟行直肠癌低位前切除手术患者，按机械抽样法随机分成2组，60例为盲肠管道式造口减压组（盲肠减压组），另外60例行常规手术作为对照。分析2组患者术后吻合口漏、消化道反应、呼吸系统感染及腹腔感染发生的差异及出现吻合口漏后的住院时间、开始进食时间和住院总费用。结果 盲肠减压组与常规手术组相比，发生吻合口漏〔(5.0%（3例）比13.3%（8例）〕、消化道反应〔15.0%（9例）比48.3%（29例）〕、呼吸系统感染〔11.7%（7例）比26.7%（16例）〕及腹腔感染〔11.7%（7例）比21.7%（13例）〕者均明显减少(Plt;0.05)。盲肠减压组中发生吻合口漏的患者与常规手术组中发生吻合口漏的患者相比，漏后住院时间〔（39±3） d比（53±4） d〕更短，进食〔（14±2） d比（25±3） d〕更早，住院总费用〔（39 620±2 033）元比（46 750±2 131）元〕降低，差异均有统计学意义(Plt;0.05)。结论 盲肠管道式造口持续减压能有效降低直肠癌低位前切除术后吻合口漏的发生率。
ObjectiveTo evaluate clinical value of colon leakage score (CLS), a preoperative predictive scoring system, for risk of anastomotic leakage after left-sided colorectal cancer surgery. MethodsThe clinical data of 310 patients who underwent left-sided colorectal cancer surgery from January 2010 to December 2014 were studied retrospectively. Risk factors for postoperative anastomotic leakage were analyzed by univariate analysis. The sensitivity and specificity of CLS system were determined by receiver operating characteristic (ROC) curve analysis. Resultsa total of 14 patients were diagnosed as anastomotic leakage. The point of CLS for the patients with anastomotic leakage was significantly higher than that for the patients without anastomotic leakage (14.21±5.76 versus 4.43±3.36, t=9.474, P=0.000). The results of ROC curve analysis showed that the sensitivity and specificity of the CLS system were 92.9% and 88.6%, respectively. The area under the curve was 0.957 (95% CI 0.924-0.991). The best cut off value of CLS was 10 (The Youden index was 0.867). The results of univariate analysis showed that the age, preoperative hemoglobin level, status of intestinal obstruction, and blood loss were associated with postoperative anastomotic leakage (P<0.05). ConclusionThe preoperative predictive score system CLS could accurately predict occurrence of anastomotic leakage. While large, multicenter prospective randomized controlled trial is still needed to further confirm it.
ObjectiveTo evaluate the influence of sidestream dark field (SDF) imaging technology in laparoscopic anterior resection (LAR) of rectal cancer on postoperative anastomotic leakage. MethodsAccording to the inclusion and exclusion criteria, the patients diagnosed with rectal cancer and underwent LAR of rectal cancer in the Sichuan Provincial People’s Hospital from October 2017 to October 2021 were retrospectively analyzed and then were divided into the study group and the control group according to whether SDF imaging technology was used during the operation. The intraoperative and postoperative data, especially the postoperative anastomotic leakage, were analyzed. ResultsA total of 90 patients were involved in this study, including 40 patients in the study group and 50 patients in the control group. There were no statistical differences in the baseline data such as gender, age, boby mass index and so on between the two groups (P>0.05). Except that the incidence of anastomotic leakage in the study group was lower than that in the control group (P<0.05), there were no statistical differences in other indexes during and after operation between the two groups (P>0.05). The operation plans were changed in 8 patients of the study group. Except for the total vessel density (P=0.962), the microvascular flow index, perfusion vessel proportion, and perfusion vessel density in the last measurement of these 8 patients were higher than those in the first measurement (P<0.05). ConclusionFrom preliminary results of this study, real-time evaluation of intestinal microcirculation by SDF imaging technology can help surgeons evaluate microcirculation perfusion at the intestinal anastomosis and provide an important reference for surgical decision-making.
ObjectiveTo study feasibility of sheath technique with seromuscular sleeve of pedicled colon in preventing anastomotic leakage following laparoscopic anterior resection of rectal cancer.MethodsThe clinical data of patients who underwent laparoscopic anterior resection of rectal cancer in our hospital from January 2017 to March 2020 were retrospectively collected. According to different surgical methods, they were divided into two groups: pedicled seromuscular sleeve sheath group (referred to as sleeve sheath operation group) and traditional operation group. The intraoperative and postoperative statuses were compared between these two groups.ResultsIn this study, 87 patients with rectal cancer were included, 37 in the sleeve sheath operation group and 50 in the traditional operation group. There were no significant differences in the baseline data such as the gender, age, body mass index (BMI), complicating disease, distance from lower tumor margin to anal verge, histological classification, neoadjuvant radio- chemotherapy, and TNM stage between the two groups (P>0.05). There were no significant differences in the volumes of intraoperative blood loss, the number of lymph node dissection, the first postoperative anal exhaust time and the hospitalization expense between the two groups (P>0.05). Compared with the traditional operation group, the operative time of the sleeve sheath operation group was longer (P<0.05), the postoperative hospitalization time of the sleeve sheath operation group was shorter (P<0.05). The incidence of postoperative anastomotic leakage in the sleeve sheath operation group and the traditional group were 0.0% (0/37) and 12.0% (6/50), respectively, and the difference was statistically significant (P<0.05). There were no significant differences in the anastomotic stenosis, the lymphatic fistula and the incision infection between the two groups (P>0.05). All patients were followed-up for 6 to 36 months, with a median time of 21 months. No recurrence or death occurred.ConclusionThe sheath technique with seromuscular sleeve of pedicled colon can increase the anti tension ability of anastomotic stoma and reduce the incidence of anastomotic leakage, which is a safe and effective surgical method.
In a series of experiments on rats,we have observed that the tensile strength and hydroxyproline content of left colonic anastomosis presented the lowest level on the 3rd and 4th postoperative days. Aprotinin,dimethyl sulfoxide,superoxide dismutase and vitamin A could improve the early coures of healing of colonic anastomosis;hydroxycortisone could retard the early course of healing of anastomosis and vitamin A antaonize the deleterious effect as mentioned above. Perioperative chemotherapy did not impair the early coures of healing of colonic anastomosis. The primary rasection and anastomosis of left colon for complete obstruction could be safety done if colonic content was decompressed before performing anastomosis and abdominal cavity was irrigated with antibiotic solutions afterwards. The mechanism of some factors influencing the healing of colonic anastomosis is discussed.