Modified method for bronchial suture by Ramirez Gama compared to separate stitches suture: experimental study

OBJECTIVE: To experimentally compare two classic techniques described for manual suture of the bronchial stump.METHODS: We used organs of pigs, with isolated trachea and lungs, preserved by refrigeration. We dissected 30 bronchi, which were divided into three groups of ten bronchi each, of 3mm, 5mm, and 7mm, respectively. In each, we performed the suture with simple, separated, extramucosal stitches in five other bronchi, and the technique proposed by Ramirez and modified by Santos et al in the other five. Once the sutures were finished, the anastomoses were tested using compressed air ventilation, applying an endotracheal pressure of 20mmHg.RESULTS: the Ramirez Gama suture was more effective in the bronchi of 3, 5 and 7 mm, and there was no air leak even after subjecting them to a tracheal pressure of 20mmHg. The simple interrupted sutures were less effective, with extravasation in six of the 15 tested bronchi, especially in the angles of the sutures. These figures were not significant (p = 0.08).CONCLUSION: manual sutures of the bronchial stumps were more effective when the modified Ramirez Gama suture was used in the caliber bronchi arms when tested with increased endotracheal pressure.【研究目的】本实验旨在通过对照实验，对比两种经典的支气管残端（bronchial stump）手工缝合技术。【实验方法】本研究采用经冷藏保存的离体猪气管-肺标本，共解剖获取30支支气管标本，按管径分为3组，每组10支，分别对应3mm、5mm及7mm管径。每组内的5支标本采用单纯间断黏膜外缝合术式，剩余5支则采用由Ramirez首创、经Santos等学者改良的缝合技术。缝合完成后，通过气管插管施加20mmHg气道压力，采用压缩空气通气法检测吻合口密封性。【实验结果】改良Ramirez-Gama缝合技术在3mm、5mm及7mm管径的支气管标本中均展现出更优的密封性能，即便施加20mmHg的气管内压力，仍未出现漏气现象。而单纯间断缝合术式的密封效果欠佳，15支接受测试的支气管中有6支发生漏气，尤其好发于缝合夹角处。上述组间差异未达到统计学显著性（p=0.08）。【研究结论】在施加升高的气管内压力进行密封性测试的条件下，采用改良Ramirez-Gama缝合技术进行不同管径支气管残端手工缝合，可获得更优的密封效果。