Souza Filho Zacarias Alves de, Greca Fernando Hintz, Noronha Lúcia de, Maranhão André Souza de Albuquerque, Calil Ana Paula, Hubie Danila Pinheiro, Barbosa Fabiana Matos
PUCPR, Brazil.
Acta Cir Bras. 2007 Mar-Apr;22(2):147-51. doi: 10.1590/s0102-86502007000200013.
Experimental evaluation of the abdominal wall healing in reoperations on the same surgical site, by means of macroscopic analysis, histological and breaking strength studies of the surgical scar.
Twenty-four rats were selected and divided in 3 groups (G1, G2 and G3). A medium longitudinal laparotomy was performed, followed by laparorrhaphy on two synthesis planes, using an interrupted suture technique. The reoperations were performed in the same way, on the same surgical site. On the first day of the study all the 24 rats were operated, on the 30th day the 16 animals belonging to G2 and G3 were reoperated, and finally, on the 60th day, the 8 rats from G3 were operated for the third and last time. After 30 days of the last laparotomy of each group, euthanasia was performed. Complications such as adhesions were evaluated during the resection of surgical site. The breaking strength study was performed next, followed by the microscopical collagen analysis, using for that histological cuts stained with picrosirius.
The adhesions were prevalent in G2 and G3 (16% each) when compared to G1. No significant difference was found in the breaking strength study. Statistically significant difference was observed in collagen concentration analysis. It was found higher mature collagen (type I) as well as total collagen concentration in the groups operated more than once (G2 and G3). The highest concentration of mature collagen (p<0,0001) and total collagen (p<0,0021) were found in G3 followed by G2 and G1 (in this sequence).
The highest mature collagen concentration on the experimental groups, points out the importance of inflammatory activity in the healing process; in the resutures of the abdominal wall the surgical scar maturity is faster acquired than in the primary sutures; in relation to the primary sutures, the resutures of the abdominal wall did not influence in the resistance of the surgical scar.
通过对手术瘢痕进行宏观分析、组织学和抗张强度研究，对同一手术部位再次手术时腹壁愈合情况进行实验评估。
选取24只大鼠，分为3组（G1、G2和G3）。进行正中纵行剖腹术，然后在两个缝合平面采用间断缝合技术进行腹壁缝合。在同一手术部位以相同方式进行再次手术。研究第一天对所有24只大鼠进行手术，第30天对G2和G3组的16只动物进行再次手术，最后在第60天对G3组的8只大鼠进行第三次也是最后一次手术。每组最后一次剖腹术后30天实施安乐死。在手术部位切除过程中评估粘连等并发症。接下来进行抗张强度研究，然后进行微观胶原分析，为此使用天狼星红染色的组织切片。
与G1组相比，G2和G3组粘连情况更为普遍（每组均为16%）。抗张强度研究未发现显著差异。胶原浓度分析观察到统计学显著差异。在多次手术的组（G2和G3）中发现成熟胶原（I型）以及总胶原浓度更高。G3组成熟胶原浓度最高（p<0.0001），总胶原浓度最高（p<0.0021），其次是G2组和G1组（按此顺序）。
实验组中成熟胶原浓度最高，表明炎症活动在愈合过程中的重要性；在腹壁再次缝合中，手术瘢痕成熟比初次缝合更快获得；与初次缝合相比，腹壁再次缝合对手术瘢痕的抗阻力没有影响。
