The Experimental Study On Transgastrosubmucosa Gastroesophageal Mucosa-Mucosa Anastomosis

Objective:To study the healing quality,effects on the antireflux and role of preventing anastomotic stenosis in transgastrosubmucosa gastroesophageal mucosa-mucosa anastomosis.Methods:The 15 pigs(group A)underwent transgastrosubmucosa gastroesophageal mucosa-mucosa anastomosis,while another 15 pigs(group B) underwent the intermittent whole-layer anastomosis with silk.In comparison with these two groups,the anastomosis was observed by general and histologic study on 3th,5th and 25th postoperative day(POD).The operation time was taken notes in operation.The expression of the cytokines relating to wound healing such as vascular endothelial growth factor(VEGF)was detected by ELISA technique. Esophageal manometer,pH-metry and measureing diameter of anastomosis was made in postoperation.These parameters of two group pigs were compared and analyzed.Results:①In group A,the stoma mucosa was in a better cooperation and had a thin scar.In comparison with group B,the count of the inflammation cells and fibroblasts increased at the early period of postoperation(P＜0.05),while decreased later period(P＜0.05).In group B,the stoma mucosa was in a worse cooperation,the scar thicker and the muscle exposed frequently.The count of the inflammation cells and fibroblasts was litter,but they had more later on.②The cytokine in group A was a high expression and active in the early stage.There was a little expression on POD 25th.In group B,it had a low expression in early period,and still a higher expressing level up to POD 25th.③At different postoperation time,the pH deviation above stoma 3 to 5 centimeter and below the stoma in two group is significant,comparied with group B.In group B,there is always food and bile in esophagus,but there was none in group A.On the 25th postoperative day,esophageal manometry showed that resting press deviation above stoma 3 to 5 centimeter and below the stoma had significant.④On the 25th postoperative day,in group A,the stoma mucosa had a thin scar,soft and elastic.In groupB,it was thick scar,hard and unelastic..The diameter of stoma in group A was larger than that in group B.Conclusion:①In the aspect of tissue regeneration and wound repairing, transgastrosubmucosa gastroesophageal mucosa-mucosa anastomosis had a higher healing quality than intermittent whole-layer.It can decrease the occurrence of anastomosis leakage.②The stoma mucosa in transgastrosubmucosa gastroesophageal mucosa-mucosa anastomosis was in a better cooperation and softer than the other,deviation of pH and esophageal manometry above stoma 3 to 5 centimeter and below the stoma was significant.It showed that the effect of preventing gastroesophageal reflux was remarkable and more definite in transgastrosubmucosa gastroesophageal mucosa-mucosa anastomosis than that in the intermittent whole-layer anastomosis with silk.③In middle-long term experimental study,The diameter of stoma in transgastrosubmucosa gastroesophageal mucosa-mucosa anastomosis was larger than the other.Transgastrosubmucosa gastroesophageal mucosa-mucosa anastomosis can better preventing anastomotic stricture than the intermittent whole-layer anastomosis with silk.④Although it took us longer operation time than the latter,the transgastrosubmucosa gastroesophageal mucosa-mucosa anastomosis is an ideal operation method.