de Hingh I H J T, de Man B M, Lomme R M L M, van Goor H, Hendriks T
Department of Surgery, University Medical Centre Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
Br J Surg. 2003 Aug;90(8):981-8. doi: 10.1002/bjs.4146.
Clinical studies report conflicting results on the safety of primary intestinal anastomoses in the presence of peritonitis, and comprehensive experimental data are lacking. The present study investigated whether the strength of experimental colonic anastomoses is affected if surgery is performed in the presence of pre-existing bacterial peritonitis.
Colonic anastomoses were constructed in Wistar rats 24 h after caecal ligation and puncture or a sham procedure. Anastomotic strength was assessed by measuring breaking strength and bursting pressure during the first 5 days after operation. Anastomotic hydroxyproline levels were measured and matrix metalloproteinase (MMP) activity was analysed by quantitative gelatin zymography.
Anastomotic strength was lowered in the presence of bacterial peritonitis but in a minor and transient way. The breaking strength was lower only immediately after construction of the anastomosis (- 15 per cent, P = 0.011) and the bursting pressure only on the third postoperative day (- 33 per cent, P = 0.038); no anastomotic dehiscence was observed. At 3 days after operation increased levels of MMP activity were observed but anastomotic hydroxyproline content was not affected by bacterial peritonitis.
The influence of bacterial peritonitis on the development of anastomotic strength is limited. This experimental finding lends support to recent clinical studies that have demonstrated the feasibility of constructing a primary anastomosis under these conditions.
临床研究对于腹膜炎情况下一期肠吻合术安全性的报道结果相互矛盾，且缺乏全面的实验数据。本研究旨在调查在已有细菌性腹膜炎的情况下进行手术时，实验性结肠吻合口的强度是否会受到影响。
在盲肠结扎和穿刺或假手术24小时后，于Wistar大鼠身上构建结肠吻合口。通过测量术后前5天的断裂强度和爆破压力来评估吻合口强度。测量吻合口羟脯氨酸水平，并通过定量明胶酶谱分析基质金属蛋白酶（MMP）活性。
在细菌性腹膜炎存在的情况下，吻合口强度降低，但程度较轻且为短暂性。仅在吻合口构建后即刻断裂强度较低（降低15%，P = 0.011），仅在术后第3天爆破压力较低（降低33%，P = 0.038）；未观察到吻合口裂开。术后3天观察到MMP活性水平升高，但细菌性腹膜炎未影响吻合口羟脯氨酸含量。
细菌性腹膜炎对吻合口强度发展的影响有限。这一实验结果为近期临床研究提供了支持，这些研究表明在这些情况下进行一期吻合术是可行的。
