大鼠颈总动脉端端吻合术后的血流动力学动态观察

研究小动脉端端吻合术后血流动力学变化，为进一步的研究提供依据。选用ＳＤ大鼠１０只，切断左侧颈总动脉行端端吻合。术后６，１２，２４，４８，７２和１２０小时，用彩色多普勒血流仪经皮连续测定实验侧颈总动脉吻合口近端、吻合口、吻合口远端，以及对照侧颈总动脉的收缩期最高血流速度，计算吻合口横切面的狭窄面积百分比。结果显示，术后各个时间段，吻合口收缩期最高血流速度均明显高于吻合口近端、吻合口和对照侧颈总动脉的血流速度（Ｐ＜０．０５）；吻合口远端的收缩期血流速度均低于吻合口近端和对照侧颈总动脉的血流速度（Ｐ＜０．０５），血流速度分别降低３３．１８％和３３．３３％。术后６小时～１２０小时均出现不同程度的狭窄，平均减少４２．４８％。认为，小动脉端端吻合术后６小时～１２０小时，吻合口血流速度均明显高于吻合口近端和吻合口远端的血流速度；吻合口远端的流速均明显低于吻合口近端的流速；吻合口及其近、远端的血流速度变化不一致。     

人体四肢动脉伤端端吻合术后血流动力学变化

目的　研究人体四肢动脉伤端端吻合术后血流动力学变化，为评价临床修复效果及近、远期疗效提供依据。方法　应用多谱勒超声仪对２１ 例患者的２７ 条端端吻合术后血管的通畅情况进行随访观察。应用受约束弹性管模型，在体测量流量波形，分析吻合血管的血流动力学特性。结果　术后早期２７ 条血管全部通畅，２１ 例患者中１５ 例获半年以上随访，血管均通畅。与健侧对照，术后每搏血流量（ＳＶ）下降，吻合口处血流平均速度（Ｖｍ）升高，壁面剪应力（τ） 下降，但各血管吻合口处与近、远端血管及健侧血管之间差异无显著性意义（ Ｐ ＞ ０．０５）。无论随访时间≤２４ 周或＞２４ 周的患者，其上、下肢血管吻合口处的Ｖｍ 均较健侧升高，ＳＶ 降低，τ下降，但差异无显著性意义（Ｐ ＞ ０．０５） 。两时间组的血流搏动指数（ＰＩ） 间差异无显著性意义（ Ｐ ＞ ０．０５）。随访时间≤２４ 周者，Ｖｍ 高于术后时间＞ ２４ 周者，ＳＶ 及τ均降低，但两时间组之间差异无显著性意义（ Ｐ ＞ ０．０５）。结论　血流动力学参数与血管壁面剪应力是辅助评价血管损伤吻合修复效果的良好参数指标，定期、连续观测有助于预测吻合修复血管的转归。     

急腹症术后应用复方大承气汤的疗效观察

本文报告１２０例急腹症术后口服复方大承气汤（中药组）的临床效果，并与同期６０例急腹症术后患者（对照组）进行了比较。结果：①中药组术后１２、２４小时肠音分别比对照组多１．７和２．１次／分。术后排气、排便时间分别比对照组提前３２．６和２８．８小时（Ｐ〈０．００１）；②中药组术后并发症比对照组少１２．５％（Ｐ〈０．０５）；③对部分患者的随访结果表明，中药组术后肠粘连的发生率比对照组少１９．４５％（Ｐ〈０     

盐酸丁哌卡因硬膜外阻滞对肝酶谱及血浆蛋白参数的影响

应用盐酸丁哌卡因硬膜外阻滞后．测定术毕、术后２４小时印术后一周肝酶谱及血浆蛋白参数动态变比，并与利多卡因进行比较。结果表明：丁哌卡因组（丁组）ＡＬＢ、ＣＰ、ＣＨＥ与术前对照组比较术毕和术后２４小时降低（Ｐ＜０．０１和Ｐ＜０．０５）α－ＡＴ在术毕和术后２４小时增高（Ｐ＜０．０５）。ＡＫＰ和γ－ＣＴ分别在术毕和术后２４小时增高（Ｐ＜０．０５和Ｐ＜０．０１）。术后一周各项指标恢复正常。利多卡因组（利组）仅α－ＡＴ术后２４小时增高（Ｐ＜０．０５）。丁组与利组两组间比较结果：ＣＰ和ＡＤＡ在术毕有显著性差异（Ｐ＜０．０１和Ｐ＜０．０５）。     

动静脉转流重建缺血脑组织循环的实验研究

将２８只新西兰白兔随机分成实验组（２０只）和对照组（８只）。对照组结扎双侧颈总动脉，实验组在结扎双侧颈总动脉后将右颈总动脉头向转流入面总静脉远侧的颈入静脉，并在手术前后各取入颅动脉和出颅静脉血作血气分析。术后实验组与对照组都均分成四个亚组，分别在术后４８小时与１４天作组织学检查、１４天作脑血管造影并墨汁灌注和长期存活观察。结果，二组动物均存活。实验组手术前后血气无统计学差异（Ｐ＞０．０５），脑血流丰富、通畅，细胞正常；对照组脑血流不足，细胞广泛坏死。作者认为动静脉转流确可重建缺血脑组织循环。     

山莨菪碱对体外循环心脏手术后白细胞变形力的影响

为观察山莨菪碱对体外循环（ＣＰＢ）心脏手术后病人白细胞变形能力（ＬＤ）的影响，进一步探讨该药改善微循环的机制。将１６例体外循环下心脏手术病人均分为实验、对照组。实验组于术后６０分钟静脉注射山莨菪碱０．２ｍｇ／ｋｇ。两组分别于术前、术后６０、给药后３０、６０分钟采外周血，测定白细胞变形力。结果显示，ＣＰＢ术后６０分钟两组白细胞变形力均明显降低（Ｐ＜０．０１），组间差异无显著性（Ｐ＞０．０５）。实验组给药后３０分钟ＬＤ高于对照组（Ｐ＜０．０１），但两组仍低于术前（Ｐ＜０．０１），给药后６０分钟实验组ＬＤ恢复至术前水平（Ｐ＞０．０５），明显高于对照组（Ｐ＜０．０１）。结论：ＣＰＢ术后ＬＤ降低，山莨菪碱对微循环的改善除作用于血管平滑肌及内皮外，提高ＬＤ亦起着重要作用     

龙津降纤酶对小血管吻合口内皮细胞愈合的影响

目的 研究龙津降纤酶对小血管吻合口内皮细胞愈合的影响。方法 采用ＳＤ大鼠颈总动脉切断后作端端吻合的模型。根据用药的不同分为龙津降纤酶组、肝素钠组和对照组３组,每组１０只大鼠。根据取材时间,３组各分为术后１５ｍｉｎ、３０ｍｉｎ、１ｈ、２４ｈ和７ｄ共５组。样本用扫描电镜观察血管吻合口内皮细胞的修复过程。结果 龙津降纤酶组血管吻合口的针孔与缝线表面无明显血小板的堆聚,内皮细胞生长时间明显早于对照组,但与     

深静脉高营养（TPN）预防食管癌切除术后吻合口瘘的临床研究

本研究收集食管癌行食管癌切除胃代食管术病例２６５例，分为未用深静脉高营养组（ＮＴＰＮ）和深静脉高营养组（ＴＰＮ）。分别对各组临床资料进行比较分析，结果显示：ＴＰＮ组葡萄糖供给量（８．３７±２．１２ｇ／ｋｇ／２４小时）显著高于ＮＴＰＮ组（２．７７±０．７１ｇ／ｋｇ／２４小时）（Ｐ＜０．０１），（０．３０±０．１４ｇ／ｋｇ／小时）Ｐ＜０．０５。吻合口瘘发生率ＴＰＮ组（２．１％）则显著低于ＮＴＰＮ组（１５．２％）Ｐ＜０．００１。结果提示ＴＰＮ组可明显降低吻合口瘘发生率。作者于ＴＰＮ促进吻合的愈合，预防吻合口瘘发生的有关机理进行了讨论。     

等距对称分叶法吻合小血管的实验及临床应用研究

目的：吻合口管壁等距对称分叶后吻合小血管，确保吻合口管壁完全外翻；内膜平整对合，降低血管危象的发生率，提高通畅率。方法：将吻合口管壁纵形剪开分叶，剪开的深度为管壁厚的２倍，小血管分３叶者吻合６针，４叶者８针。用二定点法先缝合叶部，后缝合２叶之间。用此法共吻合大白鼠尾动脉１００个吻合口，免股动脉和肱动脉１２０个吻合口，免耳皮瓣自体交叉移植２０个，用此法进行断手指再植１５例，游离皮瓣移植５例。结果：１００个大白鼠尾动脉吻合后即刻通畅率为１００％，１２０个股、肱动脉吻合后３周其通畅率为９７．５％（３个吻合口因伤口感染栓塞），吻合前、吻合后３周时吻合口内径经ｔ检查无显著差异（Ｐ＞０．０５），兔耳皮瓣全部成活，临床应用２０例全部成功。未发生血管危象。吻合口经扫描电镜观察，愈合过程优于端端吻合法。结论：此法吻合微小血管能确保其吻合口管壁外翻，内膜平整对合，减少缝合针数。有利于吻合口的无创操作，使血管的通畅率提高，血管危象减少     

硝苯地平对大鼠颈总动脉端端吻合术后血流速度的影响

目的 研究硝苯地平（ｎｅｆｅｄｉｐｉｎｅ））对小动脉端端吻合后血流速度的影响。为血管吻合后临床应用硝苯地平的时间提供依据。方法 取ＳＤ大鼠４８只,切断左侧颈总动脉后作端端吻合。按术后所给药物的不同随机分成两组。实验组：术后用硝苯地平灌胃（１．０ｍｇ／ｋｇ）;对照组用同等体积生理盐水灌胃。按给药时间又分成术后２４、４８和７２ｈ３个给药时间组。每组均在给药后１、３、５和７ｈ,用彩色多普勒超声仪检测左侧     

Influence of the stable prostacyclin analog iloprost on the healing of colonic anastomosis in rats

AIM: The aim of this study was to investigate whether iloprost injected intraperitoneally immediately after colon resection can improve anastomotic healing on the fifth and eighth postoperative days. METHODS: Forty Wistar rats were randomised into 2 equal groups. After the resection of a 1 cm segment of transverse colon, an end to end sutured anastomosis was generated. From the day of the operation, group 1 (control) received intraperitoneal 3 cc saline solution once daily until sacrifice, while group 2 (iloprost) received iloprost in a dose of 2 mg/kg body weight intraperitoneally once daily until sacrifice. Each group was further randomly divided into 2 equal subgroups and animals were sacrificed on the fifth (subgroup A), and eighth (subgroup B) postoperative days. After sacrifice, anastomoses were examined macroscopically and were measured for bursting pressures and tissue hydroxyproline levels while anastomotic healing process was evaluated histopathologically. RESULTS: None of the rats exhibited any clinical evidence of leakage and there were no instances of peri-anastomotic abscess or peritonitis. Bursting pressure on the fifth postoperative day was significantly higher in the iloprost group than in the control group (P<0.001), while on the eighth postoperative day, bursting pressure was higher in the iloprost group but not significantly different (P=0.165). On both the fifth and eighth postoperative days rats in the iloprost group developed significantly more marked neo-angiogenesis and, in parallel with this, there was a trend showing a higher inflammatory cell infiltration. CONCLUSION: The intraperitoneal administration of iloprost promoted neo-angiogenesis and enhanced colonic healing on the fifth postoperative day.     

高压氧对大白鼠颈动脉吻合口愈合的影响

目的　观察高压氧对大白鼠颈动脉吻合口愈合的影响。方法　 3 6只SD大白鼠 ,建立切断颈动脉后再吻合的模型。实验组 :术后高压氧治疗共 2 4只大鼠。对照组 :术后不作处理共 12只大鼠。术后 1、3、5、7d 4个时间组处死动物 ,取颈动脉样本 ,行光镜和免疫组化观察。用计算机图像分析系统比较血管各层的厚度。结果　术后 1、3d两组颈动脉内膜、中膜和外膜的厚度 ,无明显差别 (P >0 .0 5 )。术后7d ,对照组颈动脉中膜、外膜的厚度均大于实验组 (P <0 .0 5、P <0 .0 1)。免疫组化结果证实对照组的外膜有明显的炎症反应及纤维母细胞增生。结论　高压氧可减少炎症和纤维母细胞的增生 ,有促进动脉吻合口的愈合作用。     

The effects of platelet‐rich‐plasma gel application to the colonic anastomosis in hyperthermic intraperitoneal chemotherapy: An experimental rat model

Hyperthermic intraperitoneal chemotherapy (HIPEC) has cytotoxic effects on tumour cells but also negative impacts on anastomotic healing. Platelet‐rich‐plasma (PRP) is used for wound care but data about effects on gastrointestinal anastomosis are limited. In this experimental study, we aimed to investigate the effects of PRP application on colon anastomosis in rats those received HIPEC with cisplatin. Five rats were sacrificed to obtain PRP gel. Thirty rats were divided into three groups; Group 1: control group, Group 2: colon anastomosis and HIPEC with cisplatin, and Group 3: colon anastomosis enhanced by PRP and HIPEC with cisplatin. The rats were re‐operated on postoperative day seven and anastomotic bursting pressure (ABP) was recorded. Also, tissue samples were taken for hydroxyproline assessment and histopathological examination. There were significant differences in ABP between Groups 2 and 3, and also those groups had lower ABP compared with the control group. Group 3 had significantly higher hydroxyproline levels and had better histopathological findings than group 2. According to our findings, we suggest that PRP application improves the anastomotic healing by increasing anastomotic bursting pressure, hydroxyproline levels, and decreasing inflammatory response. Further clinical studies are needed to prove our hypothesis.     

The Effects of Sildenafil Citrate on Ischemic Colonic Anastomotic Healing in Rats: Its Relationship Between Nitric Oxide and Oxidative Stress

BACKGROUND: The purpose of this study was to examine the effects of sildenafil citrate on normal and ischemic colon anastomosis in the rat model by measuring the levels of blood and colonic tissues nitric oxide, thiobarbituric acid reactive substrates (as a marker of lipid peroxidation), and glutathione (as an antioxidant). METHODS: Normal (group 1 and 3) and ischemic anastomosis (group 2 and 4) were performed in four equal rat groups (n = 14). Orally 10 mg/kg per day of sildenafil citrate therapy were applied in group 3 and group 4 after operation. Seven rats of the each group were killed on postoperative days 3 and 7. RESULTS: Sildenafil citrate therapy was resulted in elevated nitric oxide levels in both normal and ischemic anastomotic tissues (p < 0.0001 and p < 0.03) at postoperative day 3. Tissue thiobarbituric acid reactive substrate levels were elevated in rats with normal anastomosis by sildenafil therapy (p < 0.001) at postoperative days 3 and 7 (p < 0.05). Sildenafil therapy given to the normal anastomosis group has significantly higher tissue nitric oxide levels than the normal anastomosis group without therapy at postoperative day 7 (p < 0.001). On postoperative day 7, plasma nitric oxide levels were decreased by sildenafil citrate in rats with normal (p < 0.01) and ischemic anastomosis (p < 0.05). The beneficial effect of sildenafil citrate also was seen for erythrocyte glutathione levels in rats with normal anastomosis at postoperative day 7 and in rats with ischemic anastomosis at postoperative day 3. CONCLUSIONS: Our results suggest that sildenafil citrate may affect ischemic anastomotic healing due to its possible effects on nitric oxide metabolism and lipid peroxidation. However, functional implication of this agent further needs to be elucidated.     

Comparison of the effects of various anticancer agents on intestinal anastomosis after intraperitoneal administration

In this study, the effects of intraperitoneal 5-fluorouracil (5-FU), cisplatinum (Cis), adriamycin (Adr), and methotrexate (MTX) administration on rat intestinal anastomosis were compared. Cis and MTX led to significant weight loss in the first 5 days compared with the control group. Within 14 days all rats except the MTX group nearly reached their preoperative weight. No remarkable weight loss or systemic toxicity was observed among the 5-FU and Adr groups. The anastomosis bursting pressure (ABP) at 1 week was significantly lower than that of the control group (P<0.01 andP<0.005, respectively). On day 14 the anastomosis bursting pressure in the Cis group was similar to that of the control group but was significantly lower in the MTX group (P<0.002). Histopathologically, MTX avoided the development of a mucosal layer at the anastomosis site and led to ulcer formation in some of the rats. The ABPs at 7 and 14 days were similar to those in the control group. Neither of the agents had any significant mechanical or histopathologic adverse effects on anastomosis. According to the results of our study, MTX impaired the healing of the anastomosis, and we thus conclude that the intraperitoneal administration of this agent is not safe. On the other hand, Cis showed a detrimental effect on the anastomosis, particularly in the early phase, but this effect disappeared in the late phase. Cis thus should not be administered in the early postoperative phase. As a result, 5-FU and Adr were found to be the safest agents as they did not delay wound healing and did not reduce the anastomotic strength.     

End-to-end oesophageal anastomosis: an experimental study in the rat

To study the effects of suture material, calibre and tension on the end-to-end oesophageal anastomosis, the cervical oesophagus of the rat was resected for 2.5 mm, 7.5 mm and 12.5 mm respectively in three groups of 60 rats each. End-to-end anastomosis was performed with either 6/0 silk, 6/0 polypropylene or 9/0 polypropylene sutures. There was no postoperative leakage. Mortality was mainly due to hair bolus obstruction at the site of anastomosis. There was no difference in mortality and anastomotic stenosis between groups with different resection lengths. Within each group, however, mortality and anastomotic stenosis were significantly higher in the subgroup of rats with 6/0 silk suture than that in the subgroup with 6/0 polypropylene sutures, which also had significantly higher mortality and anastomotic stenosis than the subgroup with 9/0 polypropylene sutures. Histological examination of the stenosed anastomosis showed disruption of muscle layers and submucosal thickening. It is concluded that the use of fine calibre sutures of biologically inert material would be preferred for the end-to-end anastomosis of the oesophagus.     

砂仁对大鼠小肠吻合口愈合的影响

目的：探讨砂仁对大鼠小肠吻合口愈合的影响。方法：90只SD大鼠,随机分为模型组、砂仁组和普鲁本辛组,每组30只,均行小肠端端吻合。砂仁组在造模后灌胃给予砂仁溶液（按生药计,0.25g/kg）,普鲁本辛组在造模后灌胃给予普鲁本辛（3.5mg/kg）溶液。术后3、5、7d观察小肠吻合口病理学改变、吻合口爆破压、羟脯氨酸含量 术后7d测量小肠系膜微静脉血流流速。结果：砂仁组吻合口局部炎症轻于其他两组,胶原纤维排列较好 术后5,7d吻合口羟脯氨酸、爆破压高于模型组和普鲁本辛组（P〈0.05） 术后7d肠系膜微静脉血流流速高于模型组和普鲁本辛组（P〈0.05）。结论：砂仁口服能够促进大鼠小肠吻合口的愈合。