Buyne Otmar R, Bleichrodt Robert P, van Goor Harry, Verweij Paul E, Hendriks Thijs
Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 91091, 6500, HB Nijmegen, The Netherlands.
Int J Colorectal Dis. 2007 Jul;22(7):819-25. doi: 10.1007/s00384-006-0222-6. Epub 2006 Nov 7.
Optimal therapy of secondary peritonitis frequently results in the formation of residual abscesses, which bear a substantial mortality and morbidity. This study aims to prove that fibrinolytic therapy with recombinant tissue plasminogen activator (rtPA) can reduce abscess formation after surgical treatment of secondary peritonitis in a rat model, without causing unwanted side effects.
Male Wistar rats received an intra-abdominal injection with a suspension of sterile feces, 10(5) cfu Escherichia coli and 10(4) cfu Bacteroides fragilis. Surgical debridement was performed 1 h after inoculation. Animals were randomized into four groups (n = 14 each). Three groups received human rtPA at 1 h (rtPA1); 1 h and 6 h (rtPA2); and 1, 6, and 24 h (rtPA3), respectively. Each dose contained 1.25 mg rtPA. Controls received saline only. Animals were killed after 5 days.
rtPA treatment reduced abscess formation in surviving animals, depending on number of doses given. Animals in group rtPA3 had no abscesses in contrast to 88% of the controls (mean 3.6 +/- 2.7 abscesses per rat; p < 0.05). In the rtPA1 and rtPA2 group, frequency of abscess formation was 58 and 33%, respectively. Mortality, course of body weight, and bacteremia were not affected by rtPA and neither were peritoneal cell counts and levels of TNF-alpha, IL-1beta, IL-6 and IL-10. No bleeding complications were observed.
rtPA reduces intra-abdominal abscess formation after surgical treatment of generalized peritonitis without increasing mortality or affecting the local inflammatory response.
继发性腹膜炎的最佳治疗常常导致残余脓肿的形成，这带来了相当高的死亡率和发病率。本研究旨在证明，在大鼠模型中，使用重组组织型纤溶酶原激活剂（rtPA）进行纤溶治疗可减少继发性腹膜炎手术治疗后的脓肿形成，且不会引起不良副作用。
雄性Wistar大鼠腹腔内注射无菌粪便悬液、10⁵ cfu大肠杆菌和10⁴ cfu脆弱拟杆菌。接种后1小时进行手术清创。动物被随机分为四组（每组n = 14）。三组分别在1小时（rtPA1）、1小时和6小时（rtPA2）、1、6和24小时（rtPA3）接受人rtPA治疗。每剂含有1.25 mg rtPA。对照组仅接受生理盐水。5天后处死动物。
rtPA治疗可减少存活动物的脓肿形成，这取决于给药剂量。rtPA3组动物无脓肿形成，而对照组为88%（平均每只大鼠3.6±2.7个脓肿；p < 0.05）。rtPA1组和rtPA2组脓肿形成频率分别为58%和33%。rtPA对死亡率、体重变化过程和菌血症无影响，对腹腔细胞计数以及TNF-α、IL-1β、IL-6和IL-10水平也无影响。未观察到出血并发症。
rtPA可减少弥漫性腹膜炎手术治疗后的腹腔内脓肿形成，且不增加死亡率或影响局部炎症反应。
