Saclarides T J, Rohrer D A, Bhattacharyya A K, Bapna M S
Department of General Surgery, University of Illinois College of Dentistry, Chicago.
Dis Colon Rectum. 1992 Feb;35(2):151-7. doi: 10.1007/BF02050670.
Increasing interest in the use of preoperative or intraoperative radiation therapy for cancer has led to concerns regarding tissue healing and integrity subsequent to treatment. This is especially so for intestinal anastomoses incorporating irradiated bowel, where poor healing may lead to anastomotic disruption and sepsis. One hundred thirty Sprague-Dawley rats were randomized into five groups as follows: both limbs, one limb, or neither limb of an anastomosis received 2,000 R of radiation intraoperatively. A fourth group had a segment of small bowel irradiated, with no anastomosis; a fifth group had the gut exposed by celiotomy. The control groups and all anastomoses underwent tensile strength measurements on the seventh postoperative day, with findings as follows: no anastomosis, no irradiation, 143.75 g; no anastomosis, irradiated, 114.50 g; anastomosis, no irradiation, 85.273 g; anastomosis, one limb irradiated, 78.100 g; anastomosis, both limbs irradiated, 59.00 g. There was no statistical difference in tensile strength of the anastomosis between when neither limb and when just one limb was irradiated. However, when both limbs were irradiated, the loss of strength was statistically significant (P = 0.002). Irradiation damage scores were assigned using Black et al.'s histologic scoring system. These scores were not significantly different between the irradiated segments. Inflammation and fibrosis scores for the anastomoses were also not significantly different. These results indicate that, in rats, anastomotic healing is impaired only when both limbs of the anastomosed intestine are irradiated. The normal strength of the anastomosis with only one limb irradiated cannot be explained by differences in inflammation, fibrosis, or radiation damage and is caused by an undetermined factor.
对癌症术前或术中放疗应用的兴趣日益增加，引发了对治疗后组织愈合和完整性的担忧。对于包含受照射肠段的肠吻合术来说尤其如此，愈合不良可能导致吻合口破裂和败血症。130只Sprague-Dawley大鼠被随机分为五组，如下：吻合术的双肢、单肢或均不接受术中2000伦琴的辐射。第四组对一段小肠进行照射，不进行吻合；第五组通过剖腹术暴露肠道。对照组和所有吻合口在术后第七天进行拉伸强度测量，结果如下：无吻合、未照射，143.75克；无吻合、照射，114.50克；吻合、未照射，85.273克；吻合、单肢照射，78.100克；吻合、双肢照射，59.00克。未照射任何肢体和仅照射单肢时，吻合口的拉伸强度无统计学差异。然而，当双肢都接受照射时，强度损失具有统计学意义（P = 0.002）。使用布莱克等人的组织学评分系统分配辐射损伤分数。这些分数在受照射节段之间无显著差异。吻合口的炎症和纤维化分数也无显著差异。这些结果表明，在大鼠中，仅当吻合肠段的双肢都接受照射时，吻合口愈合才会受损。仅单肢照射时吻合口的正常强度无法用炎症、纤维化或辐射损伤的差异来解释，而是由一个未确定的因素导致的。
