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氣管支 斷端 縫合에 關한 實驗的 硏究

Experimental Studies on Procedures of Bronchial Closures for Bronchial Stumps in Pulmonary Resections

대한외과학회지 1962년 4권 5호 p.283 ~ 294
이홍균,
소속 상세정보
이홍균 (  ) - 서울해군병원 외과

Abstract


Experimental studies, using dogs, have been made on suture materials to assure a method safe and reasonable for the better colsure of the bronchial stump with little danger of fistula formation. And results obtained are as follow;
1) A bronchial stump closed with a silk is apt to show marked inflammatory lesions around it and these remain for a long period giving chances for bacterial infection and subsequent danger of forming bronchopleural fistulae.
2) A catgut used for bronchial closure, as suture material, showed gradual absorption with subsquent organization and induced less inflamatory reaction on the tissue than silk.
3) A nylon filament is less traumatic to the tissue on suturing . the bronchial stump . but showed more connective tissue proliferation on the pleuural side of bronchial stumps.
4) The healing of the bronchial stump is much more promissing when the bronchial stump was closed with a less-traumatic suture material i.e., better results have been demonstrated by using stainless steel wire and exact approximation of the bronchial mucosae with meticulous care and dexterity.
5) On the pleural side of the closed bronchial stumps one observes always coverings, as healing process, consist of the adjacent remaining pulmonary tissue or regenerated endotheliar layer of the pleura but it should be expostulated that the degree of proliferation of the connective tissue covered - on the--pleural side of the closed bronchial stump does not coincidee with the certainty of the stump healing.
6) Regardless to the suture material used for stump closures, the exact apporoximation of the . bronchial mucosae with meticulous care and: dexterity is imperative to secure dangers of forming broncho-pleural fistulae and sinus formation on the bronchial stump.
7) On closing the bronchial stump "through and through technique" is liable to give chances for infection and extra-mucosal closure of the bronchial stump has the same danger of infection since improper mucosal approximation on the closure site may give way to form sinuses or pouches,.´ lined with unhealthy epithelium, . containing -bronchial secrete or extravasated blood which can be the suitable media for bacterial growths.
8) On closing bronchial stumps it seemed reasonable anatomically to use layer to layer method than epithelium to epithlium method.
9) The lingular flap method, utilizing the membranous portion of the bronchus as lingular flap, is excellent one which prevents the retention of the bronchial secretion and furthermore helps the secretion drains out well leaving no or, at least, lessen chances for the bacterial infection ´to the stump.

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