Månsson Peter, Zhang Xiao Wei, Jeppsson Bengt, Thorlacius Henrik
Department of Surgery, Malmö University Hospital, Lund University, 20502 Malmö, Sweden.
Int J Colorectal Dis. 2002 Nov;17(6):420-5. doi: 10.1007/s00384-002-0392-9. Epub 2002 Apr 16.
While mechanical parameters (breaking strength, bursting pressure) are used to measure colonic anastomotic healing, reported values are inconsistent. This study developed a novel approach to study colonic anastomotic repair and compared it with mechanical methods.
We created standardized four- and eight-suture colonic anastomoses and performed contrast enemas in rats.
All eight-suture anastomoses were tight at completion. In contrast, all four-suture anastomoses leaked immediately after the operation, but the integrity increased progressively, and at 12 h all were closed. No changes in breaking strength were observed up to 3 days postoperatively, in contrast to anastomotic bursting pressure which increased progressively over the same period. Integrity and bursting pressure increased in parallel to the anastomotic content of myeloperoxidase (MPO), indicating that neutrophil infiltration is not detrimental in normal healing. Moreover, local irradiation, which enhanced MPO activity, did not increase leakage, suggesting that neutrophil accumulation per se has no effect on the integrity of colonic anastomosis. In addition, administration of 5-fluorouracil, which decreased anastomotic MPO levels, increased anastomotic leakage.
We present a novel approach to study anastomotic healing using radiological examination. While bursting pressure appears to be suitable for measuring early anastomotic healing in the colon, we demonstrate that breaking strength is not sufficiently sensitive to be used in examination of early healing. Moreover, our data suggest that the acute inflammatory response and associated neutrophil recruitment in the anastomosis does not negatively affect healing in the rat colon.
虽然机械参数（断裂强度、爆破压力）用于测量结肠吻合口愈合情况，但报告的值并不一致。本研究开发了一种研究结肠吻合口修复的新方法，并将其与机械方法进行比较。
我们创建了标准化的四针和八针结肠吻合术，并对大鼠进行了对比灌肠。
所有八针吻合术完成时均紧密。相比之下，所有四针吻合术在术后立即渗漏，但完整性逐渐增加，并且在12小时时所有吻合口均闭合。术后3天内未观察到断裂强度的变化，与之形成对比的是，吻合口爆破压力在同一时期逐渐增加。完整性和爆破压力与吻合口中髓过氧化物酶（MPO）的含量平行增加，表明中性粒细胞浸润在正常愈合过程中并无损害。此外，增强MPO活性的局部照射并未增加渗漏，这表明中性粒细胞的积聚本身对结肠吻合口的完整性没有影响。另外，给予降低吻合口MPO水平的5-氟尿嘧啶会增加吻合口渗漏。
我们提出了一种使用放射学检查研究吻合口愈合的新方法。虽然爆破压力似乎适合测量结肠早期吻合口愈合情况，但我们证明断裂强度不够敏感，无法用于早期愈合检查。此外，我们的数据表明，吻合口中的急性炎症反应及相关的中性粒细胞募集对大鼠结肠的愈合没有负面影响。
