| Objective:To observe the gastrointestinal anastomotic tissue microcirculation and healing process after performing apposition and inverting suturing.Method:Chinese adult rabbits were randomly devided into 4 groups i.e.3d,7d,14d and 28d group.Eighteen rabbits were allotted in each group with two anastomosis on each rabbit. All rabbits were randomly labeled as odd and even numbers.In odd numbered rabbits;small intestine abscised at 20cm and 40 cm from duodenojejunal ligament and performed apposition suture annastomosis and inverted suture annastomosis at 20cm and 40 cm respectively. In even numbed rabbits the anastomosis designed same as of the odd numbered but the suturing sequence was reversed. At postoperative 24h,3d,7d,14d and 28d all rabbits were subjected to in vivo micro region blood flow measurement, capillaries count, infiltrated inflammatory cells count and measurement of collagen hyperplasia, anastomotic epithelial and smooth muscle healing process.Results:1.The naked eye in vivo observationThe naked eye in vivo observation revealed anastomotic bleeding, dehiscence and leackage.No intestinal obstruction and intraperitoneal abscess was found. In apposition stured annastomosis, tissue layers were closely attached, neat and lightly inflamed with good primary wound healing. While in inverting sutured anastomosis group;tissue dislocation, poor alignment of layers and severe inflammatory response with secondary healing was observed.2.Anastomotic micro blood flow measurementIn inverting sutured group.micro blood flow values were 49.99±2.90, 107.7±3.14,113.73±6.07,147.83±8.13 ml/min for 3d,7d,14d and 28d respectively. In apposition sutured group micro blood flow values were 49.99±2.90,107.70±3.14, 113.73±6.07,147.83±8.13ml/min for 3d,7d,14d and 28d respectively. Normal intestinal micro blood flow value was 172.68±2.45 ml/min.(i)There was highly significant statistical difference between inverted sutured and apposition sutured group in 3d,7d,14d and 28d(P<0.01).(ii) There was highly significant statistical difference between inverted sutured and normal group in 3d,7d (P<0.01).(iii)There was significant statistical difference between apposition sutured and normal group in 3d,7d (P<0.05).3.Proliferating Capillaries countIn both groups anastomotic tissue specimen were collected at 3d,7d,14d and 28d to perform proliferating capillaries count. In apposition sutured group;proliferating capillaries count values were 7.2±0.97,10.0±2.55,11.0±1.75,12.7±2.25 for 3d,7d,14d and 28d respectively. In inverted sutured group;proliferating capillaries count values were 9.8±1.53,12.0±2.74,12.8±1.96,14.0±2.80 for 3d,7d,14d and 28d respectively. The intestinal normal capillaries count value was 14.2±1.52.(i)There was significant statistical difference between inverted sutured and apposition sutured group in 3d,7d,14d and 28d(P<0.05).(ii) There was no significant statistical difference between apposition sutured and normal group at 28d (P<0.05).but in all other time frames(3d,7d,14d) there was highly significant statistical difference among inverted sutured, opposition sutured and normal group (P<0.01).4. Granular tissue collagen density measurementIn apposition sutured group the quantitative collagen density values were 7.7%±1.20,8.3%±1.52,13.0%±2.25,6.4%±2.12 for 3d,7d,14d and 28d respectively. While in inverted sutured group the values were 6.8%±0.98,10.5%±1.10, 18.3%±2.28,9.5%±3.05 for 3d,7d,14d and 28d respectively. In apposition sutured group,the collagen production was higher then that of inverted sutured at 3d but was comparatively lower in 7d,14d and 28d.There was highly significant statistical difference (P<0.01).5. Inflammatory cells detectionIn apposition sutured group the inflammatory cell count values were 2.5±0.55, 2.2±0.65,2.0±0.54 at 3d,7d and 14d respectively. In inverted sutured group the inflammatory cell count values were 0.6±0.50,1.5±0.72,2.5±0.55 at 3d,7d and 14d respectively. At 3d, there was highly significant statistical difference (P<0.01) and at 7d and 14d had statistical difference (P<0.05).6.Observation of anastomotic mucosal epithelial cellsIn apposition sutured group the apithelial cells proliferation values were 2.76±0.32,4.88±0.57,5.23±0.45,6.00±0.00 at 3d,7d,14d and 28d respectively. In inverted sutured group the epithelial cells proliferation values were 0.98±0.41, 2.52±0.55,4.8±0.32,6.00±0.00 at 3d,7d,14d and 28d respectively. At 3d the difference was of highly statistical significance (P<0.01) but had statistically significant difference at 7d and 14d (P<0.05).No difference of statistical significance found at 28d.7. Detection of anastomotic smooth muscle cell regenerationIn apposition sutured rabbits;smooth muscle thickness was 9.8±0.6,2.2±0.5, 15.5±0.8,21.0±1.5 in 3d,7d,14d and 28d groups respectively. In inverted sutured rabbits;smooth muscle thickness was 7.5±0.5,8.7±1.0,10.1±1.2,18.8±2.5 at 3d,7d, 14d and 28d groups respectively. There was difference of highly statistical between the apposition sutured and inverted sutured (P<0.01) in 3d,7d,14d groups.There was difference of statistical significance between apposition sutured and normal rabbits in 3d,7d groups (P<0.01).No difference of statistical significance found between normal and inverted sutured in 14d group.Conclusion:1.Use of apposition suture method exhibited better results in reconstruction of local microcirculation and angiogenesis of anastomotic tissues than that of inverted suture method.2.Apposition suture method improved the local micro blood flow of annastomotic tissues, reduced the exudation of inflammatory cells and production of granulation tissue.Use of apposition suture method promoted the mucosal repair and smooth muscle regeneration; which lead to better anastomotic marginal healing. |
PDF Full Text Request