腸壁欠損部に対する小腸漿膜面被覆 (serosal patch) 法による治癒過程の形態学的ならびに微細血管造影法による研究

とくに十二指腸壁欠損への応用

抄録

The surgical management of large laceration of the second and third portions of the duodenum has been a difficult problem. The intestinal serosal patch procedure using the loop of the jejunum or ileum was attempted at 2 cases of duodenal wall defects due to duodenal injury and to extensive resection of tumor neighbouring the duodenum. The present study was made on the process of wound healing and mucosal repair by macroscopic, microangiographic and histologic observation, using mongrel dogs.
The results obtained were as follows :
1. In macroscopic observation, the replacement by newly regenerated mucosa over the anastomotic area of the serosal patch of the jejunum for the duodenal defect was completed at 3 or 4 weeks postoperatively.
2. The microangiographic study revealed the following findings of vascular reconstruction in the wound area. At one week postoperatively, new vascularization on the serosal surface and a little vascular communication at the edge of the defects were observed. At 2 weeks much more vascular communications were observed from the peripheri of the defect toward the center. Furthermore, the vascular communication by matured blood vessels was completed at 4 weeks.
3. In microscopic observasion, inflammatory reactions were observed the most intensely at the margin of the anastomosis at 1 week, but initial regeneration of the mucosal epitheliums was also observed at the less inflammatory area. At 2 weeks postoperatively tubular formation in regenerated mucosa was initiated at the margin and there remained little inflammatory reactions. At 4 week or longer, covering with new mucosal epitheliums on the surface of the wound and the tubular and villous formation were completed.