术后早期腹腔内化疗后用纤维蛋白胶覆盖的结肠吻合口愈合情况。

The healing of colon anastomosis covered with fibrin glue after early postoperative intraperitoneal chemotherapy.

作者信息

Kanellos I, Christoforidis E, Kanellos D, Pramateftakis M G, Sakkas L, Betsis D

机构信息

4th Surgical Department, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Greece.

出版信息

Tech Coloproctol. 2006 Jul;10(2):115-20. doi: 10.1007/s10151-006-0263-4. Epub 2006 Jun 19.

DOI:10.1007/s10151-006-0263-4

PMID:16773289

Abstract

BACKGROUND

After colon resection for colonic cancer, the administration of antineoplastic agents may prolong survival by killing residual cancer calls and preventing metastasis, but may also slow anastomotic healing. This study was designed to determine the effects of 5-fluorouracil (5-FU) and leucovorin (LEV), injected intraperitoneally, on the healing of colonic anastomoses with or without fibrin glue (FG) covering.

METHODS

Sixty rats were randomized to one of four groups. After resection of a transverse colon segment, an end-to-end sutured anastomosis was performed. Rats in the 5-FU+LEV and the 5- FU+LEV+FG groups received 5-FU+LEV intraperitoneally. The colonic anastomoses of the rats in the FG group and in the 5-FU+LEV+FG group were covered with fibrin glue. All rats were killed on postoperative day 8. Bursting pressure measurements were recorded and the anastomoses were examined macroscopically and histologically.

RESULTS

The leakage rate of the anastomoses was significantly different among groups. Specifically, the leakage rate was significantly higher in the 5-FU+LEV group (40%) than in the FG and in the 5-FU+LEV+FG groups where there were no leakages (p=0.017). The mean adhesion formation score was significantly higher in rats of the 5-FU+LEV group, compared to the control (p=0.023), the FG (p=0.006) and the 5-FU+LEV+FG (p=0.006) groups. Bursting pressures were significantly lower in the 5-FU+LEV group than in the other groups (p<0.001). Also, bursting pressures were significantly lower in the control group compared to the FG and 5-FU+LEV+FG groups (p<0.001). Rats in the 5-FU+LEV+FG group had significantly greater neoangiogenesis and fibroblast activity than those in the 5-FU+LEV group (p=0.025).

CONCLUSION

The early intraperitoneal postoperative administration of 5-fluorouracil plus leucovorin impaired colonic wound healing. However, the application of fibrin glue prevented the deleterious effect of chemotherapy.

摘要

背景

结肠癌结肠切除术后，给予抗肿瘤药物可能通过杀死残留癌细胞和预防转移来延长生存期，但也可能延缓吻合口愈合。本研究旨在确定腹腔注射5-氟尿嘧啶（5-FU）和亚叶酸（LEV）对有或无纤维蛋白胶（FG）覆盖的结肠吻合口愈合的影响。

方法

60只大鼠随机分为四组。切除一段横结肠后，进行端端缝合吻合。5-FU+LEV组和5-FU+LEV+FG组大鼠腹腔内注射5-FU+LEV。FG组和5-FU+LEV+FG组大鼠的结肠吻合口用纤维蛋白胶覆盖。所有大鼠于术后第8天处死。记录破裂压力测量值，并对吻合口进行大体和组织学检查。

结果

各组吻合口漏出率有显著差异。具体而言，5-FU+LEV组的漏出率（40%）显著高于FG组和5-FU+LEV+FG组，后两组无漏出（p=0.017）。与对照组（p=0.023）、FG组（p=0.006）和5-FU+LEV+FG组（p=0.006）相比，5-FU+LEV组大鼠的平均粘连形成评分显著更高。5-FU+LEV组的破裂压力显著低于其他组（p<0.001）。此外，对照组的破裂压力显著低于FG组和5-FU+LEV+FG组（p<0.001）。5-FU+LEV+FG组大鼠的新生血管形成和成纤维细胞活性显著高于5-FU+LEV组（p=0.025）。