肝素对腐蚀性食管烧伤后狭窄形成的预防作用。

The preventive effect of heparin on stricture formation after caustic esophageal burns.

作者信息

Bingöl-Kologlu M, Tanyel F C, Müftüoğlu S, Renda N, Cakar N, Büyükpamukçu N, Hiçsönmez A

机构信息

Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey.

出版信息

J Pediatr Surg. 1999 Feb;34(2):291-4. doi: 10.1016/s0022-3468(99)90193-8.

DOI:10.1016/s0022-3468(99)90193-8

PMID:10052807

Abstract

BACKGROUND/PURPOSE: Preventing thrombus formation after caustic esophageal ingestion has been proposed to have beneficial effects. Therefore, an experimental study was carried out to investigate the effects of heparin on the esophagus after caustic burns.

METHODS

Caustic esophageal burns were produced in rats by irrigation with 50% NaOH as described by Liu. Rats were divided into four groups as follows: group A, animals with esophageal burns, received placebo and underwent autopsy 48 hours after caustic injury; group B, animals with esophageal burns, received subcutaneous heparin treatment and underwent autopsy 48 hours after caustic injury; group C, animals with esophageal burns, received placebo and underwent autopsy 28 days after caustic injury; group D, animals with esophageal burns, received subcutaneous heparin treatment for 7 days and underwent autopsy 28 days after caustic injury. Histopathologic evaluation was performed in all groups, and collagen content of esophageal sections was analyzed by determination of hydroxyproline levels.

RESULTS

Submucosal vascular thrombosis was encountered in all group A animals but the submucosal venules and arterioles were patent in most of group B animals. Esophageal strictures did not develop in any of group D animals, although varying degree of esophageal stenoses were encountered in all animals of group C. The circumferences of the burned segment have been narrowed to 3+/-1 mm in group C rats. There was obvious collagen deposition in submucosa, and epithelial regeneration was not complete in group C rats. Submucosa and epithelial integrity seemed normal in group D animals. Hydroxyproline contents in group D were significantly lower compared with group C (P < .05).

CONCLUSIONS

Heparin has ameliorating effects on stricture formation after caustic esophageal burn. Those effects may occur through possible anticoagulant, antithrombotic, and endothelial protective effects, and modifying effects of heparin on wound healing.

摘要

背景/目的：有人提出预防腐蚀性食管灼伤后血栓形成具有有益作用。因此，开展了一项实验研究来探讨肝素对腐蚀性食管灼伤后食管的影响。

方法

按照Liu所述方法，用50%氢氧化钠冲洗大鼠以造成腐蚀性食管灼伤。大鼠分为以下四组：A组，食管灼伤动物，接受安慰剂治疗，在腐蚀性损伤后48小时进行尸检；B组，食管灼伤动物，接受皮下肝素治疗，在腐蚀性损伤后48小时进行尸检；C组，食管灼伤动物，接受安慰剂治疗，在腐蚀性损伤后28天进行尸检；D组，食管灼伤动物，接受皮下肝素治疗7天，在腐蚀性损伤后28天进行尸检。对所有组进行组织病理学评估，并通过测定羟脯氨酸水平分析食管切片的胶原蛋白含量。

结果

A组所有动物均出现黏膜下血管血栓形成，但B组大多数动物的黏膜下小静脉和小动脉通畅。D组动物均未出现食管狭窄，尽管C组所有动物均出现不同程度的食管狭窄。C组大鼠灼伤段周长已缩小至3±1毫米。C组大鼠黏膜下有明显的胶原蛋白沉积，上皮再生不完全。D组动物的黏膜下层和上皮完整性似乎正常。D组的羟脯氨酸含量显著低于C组（P<0.05）。