Saclarides T J, Woodard D O, Bapna M, Economou S G
Department of General Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612.
Dis Colon Rectum. 1992 Mar;35(3):249-52. doi: 10.1007/BF02051017.
Many surgeons are reluctant to construct a bowel anastomosis with irradiated intestine. Previous studies have demonstrated diminished tensile strength of rat small bowel anastomoses that have been irradiated intraoperatively. To determine whether fibrin glue, a known tissue adhesive, improves the healing of these anastomoses, 69 male Sprague-Dawley rats were randomized into three anastomotic groups: Group 1, sutured ileal anastomosis without radiation or fibrin glue; Group 2, irradiated sutured ileal anastomosis without fibrin glue; and Group 3, irradiated ileal anastomosis with fibrin glue added to the suture line. Groups 2 and 3 received a single dose of 2,000 R intraoperatively. At seven days, the rats were sacrificed and the anastomotic segment was tested for breaking (tensile) strength. Anastomotic collagen content was evaluated using a hydroxyproline assay. Tensile strength results demonstrated that Group 2 was significantly weaker than Groups 1 and 3 (P = 0.001) and that the hydroxyproline content of Group 3 was significantly greater than that of Group 2 (P = 0.015). These results show that the addition of fibrin glue to an intraoperatively irradiated small bowel anastomosis improves healing, as demonstrated by both tensile strength and hydroxyproline content studies.
许多外科医生不愿用受辐射的肠管进行肠吻合术。先前的研究表明，术中接受过辐射的大鼠小肠吻合口的抗张强度会降低。为了确定已知的组织黏合剂纤维蛋白胶是否能改善这些吻合口的愈合情况，将69只雄性斯普拉格-道利大鼠随机分为三组吻合组：第1组，未接受辐射或使用纤维蛋白胶的缝合回肠吻合术；第2组，未使用纤维蛋白胶的受辐射缝合回肠吻合术；第3组，在缝合线上添加了纤维蛋白胶的受辐射回肠吻合术。第2组和第3组在术中接受了单次2000伦琴的辐射剂量。在第7天，处死大鼠，并对吻合段进行抗断裂（抗张）强度测试。使用羟脯氨酸测定法评估吻合口的胶原蛋白含量。抗张强度结果表明，第2组明显弱于第1组和第3组（P = 0.001），且第3组的羟脯氨酸含量明显高于第2组（P = 0.015）。这些结果表明，如抗张强度和羟脯氨酸含量研究所示，在术中受辐射的小肠吻合术中添加纤维蛋白胶可改善愈合情况。
