年間 4 号発行
ISSN 印刷: 2152-2057
ISSN オンライン: 2152-2073
Indexed in
BIOMECHANICAL ASPECTS OF THE PROBLEM OF RELIABILITY OF HUMAN INTESTINAL ANASTOMOSIS
要約
The problem of reliability of intestinal anastomosis (i.e., connection of hollow organs) has always been, and remains, a challenge in surgery. Inadequacy of anastomosis (leaking) is often a lethal complication. Despite a more than a century long history of the modern gastrointestinal suture, no efficient scientific approach to the problem of connection of the organs of the gastrointestinal tract has been developed. However, all major problems were formulated long time ago. One of the major issues is that of reasoned selection of the suture technique. What is preferable: an interrupted or continuous suture, a single- or multiple-row suture; what is the optimal frequency of stitches; what is the amount of material to be stitched, etc. The authors of this work have drawn a conclusion that an optimal surgery technique cannot be found by in vivo experiments. Their conclusion is based on the review of scientific literature devoted to the problem of adequacy of intestinal anastomosis in humans and animals as well as on historical experience of previous studies, for instance, the fact that unsoundness of large intestine anastomosis is recorded in about 14% of all cases clinically, and in 40−51% of cases radiologically. Therefore, the statement and the solution of the problem on optimization of all anastomotic operation parameters, including the identification of optimal criteria and the transition to dynamic modeling, should become the method for the solution of the human intestinal anastomosis (HIA) problem. The problems of mechanics are crucial among all problems. The solution of these problems will require, above all, the knowledge of the mechanical behavior of the material of an intestinal wall and of stitching threads. The criterion used to select an optimal surgery technique should be a subsequent development of anastomosis that is determined by the competition between necrosis and healing processes. However, such observations can hardly be implemented correctly in practice, though they can also be reduced to mechanical problems of blood and plasma filtration in the anastomosis formed. The work attempts to determine the entire range of biomechanical problems for intestinal anastomosis. The results of investigations of the mechanical behavior of intestinal wall material under extension in two main directions are reported. It was demonstrated, for the first time, that the dependence of stress on the tensile strain σ(ε) along the intestine axis has the form of a bimodal curve, i.e., a curve with two maxima, and a unimodal curve form in the circumferential direction. Hence, an original rational technique has been developed for processing the test results. Also, it was found, for the first time, that the presence of a suture changes the quality of the diagram of extension along the intestine axis. The authors attempt to explain these and other phenomena found.