Application Of Intestinal Temporary Storage Device In Canine Model Of Multiple Discontinuous Intestinal Injury With Hemorrhagic Shock

Objective: Abdominal war trauma often causes multiple transversal injuries to the bowel and suspicious bowel necrosis.Removal of massive damaged bowel will cause short bowel syndrome.The aim of this study was to compare the classical treatment methods and explore the feasibility of early treatment of intestinal temporary storage device in canine intestinal multiple transection and non-continuous suspicious necrosis with hemorrhagic shock model.Methods: Ten male beagle dogs were anesthetized after fasting for 12 h,and the hemorrhagic shock model was established by controlled exsanguination.Simultaneously,intestinal transection injury and five suspicious necrosis intestinal models were established by shearing off the small intestine and ligating the corresponding mesenteric vessels.Ten animals were randomly divided into two groups,the intestinal temporal reconstruction group(IR group)and the classic suture group(IL group).After 40 minutes of hemorrhagic shock,the fluid was resuscitated.In the IR group,a temporary storage device was used to reconstruct the ruptured intestines.In the IL group,the ruptured intestines were sutured,and the abdominal closure was temporarily closed with abdominal closed circle after the operation.The definitive surgery was performed 24 hours later.The early treatment time,vital signs,coagulation,endotoxin,inflammatory factors and other indicators were recorded.The changes of suspicious necrotic bowel changes were observed,and their tissues were taken for pathological examination.The length of the final excisional intestine was compared.Results: There was no significant difference in blood loss,fluid intake,operation time,vital signs,coagulation function,and lactic acid between the two groups(P>0.05).Endotoxin,TNF-a,IL-6,and IL-10 in both groups showed an upward trend.24 h after early treatment,the endotoxin(IL: 486.89 ± 129.69 pg/ml vs.IR: 269.82 ± 90.87 pg/ml;P <0.05),TNF-a(IL: 309.36 ± 97.05 pg/ml vs.IR: 168.61 The levels of ± 51.24 pg/ml;P <0.05)and IL-6(IL: 287.36+91.94 pg/ml vs.IR: 129.55+36.08 pg/ml;P<0.05)were significantly higher than those in IR group,but IL-10 levels were significantly lower than IR group(IR: 186.8 ± 61.64 pg/ml vs.IL: 76.9 ± 28.98 pg/ml;P <0.05).After the ligation of the intestines,a dog died of aspiration due to the vomit.In IL group,3 necrotic intestinal segments(3/20,15%)had no obvious changes,and the other 17 segments(17/20,85%)became necrotic and spread to adjacent intestinal segments.In IR group,7 necrotic intestinal segments(7/25,28%)became necrotic,6 segments(6/25,24%)were relieved,and other 12 segments(12/25,48%)showed no significant changes.The first time of necrosis occurred in the suspected necrotic intestine in IL group was earlier than that in IR group(IL: 4.63 + 1.87 h vs.IR: 8.75 + 3.70 h;P >0.05),and the time of necrosis occurred in the whole free intestine in IL group was 16.39 + 2.24 h.There was a significant difference between the two groups in the lengths of necrotic bowel(IR: 28.30 ± 6.76 cm vs.IL: 95.68 ± 29.31 cm;P <0.05).Pathological results show that,most suspected necrotic intestinal tissues(17/20,85%)in IL group had become necrosis with massive inflammatory cells infirtration.Most of the suspected necrotic intestinal tissues in IR group(12/25,48%)retained complete cell structure without necrosis occurred.There were no adverse events such as slipping event in the temporary storage devices or abdominal closure circles.Conclusion 1.Intestinal temporary storage device and abdominal closure circle were safe and effective in the treatment of multiple non-continuous canine bowel injury with hemorrhagic shock models.2.The reconstruction of bowel with intestinal temporary storage device can effectively reduce the bowel pressure and relieve the injury of intestinal mucosal barrier,and create favorable conditions for the recovery of suspicious necrotic bowel,and reduce the risk of short bowel syndrome.3.Abdominal temporary closure with abdominal closure circle is simple,reliable,and it can observe intestinal changes,effectively reduce the loss of heat and body fluids,relieve abdominal pressure,drainage celiac effusion.