Agren M S, Andersen L, Heegaard A M, Jorgensen L N
Department of Surgery K, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
Int J Colorectal Dis. 2008 Sep;23(9):857-61. doi: 10.1007/s00384-008-0501-5. Epub 2008 Jun 18.
To prevent colonic anastomotic dehiscence, pharmaceutical interventions should inhibit degradation of existing submucosal collagen fibers and accelerate the synthesis of new collagen molecules. Zinc has multiple functions in collagen metabolism and was recently found beneficial in colonic anastomosis repair. We have investigated the effect of daily intraperitoneal zinc (2 mg/kg) injections on the development of the biomechanical integrity of left colon anastomoses.
Sixty Sprague-Dawley male rats (median 245 g) were allocated to treatment with zinc sulfate in saline (n = 30) or with saline alone (n = 30) starting 1 h before the anastomoses were made. Serum zinc levels and anastomotic breaking strength were determined on postoperative days 3 (n = 30) and 7 (n = 30). The initial breaking strength or suture-binding capacity was determined in additional ten non-treated animals (277 g).
The breaking strength of the anastomoses decreased in the two groups combined (n = 30) by 50% (p < 0.001) on day 3 but was regained by postoperative day 7 compared with the initial anastomotic biomechanical strength. Serum zinc levels also increased from day 3 to day 7 in both intervention groups and correlated significantly with breaking strength (r = 0.57, p < 0.001). Although the median serum zinc level was 14% higher (p < 0.01) on day 7 in zinc-treated than in saline-treated animals, the breaking strength did not differ significantly between zinc-treated and saline-treated rats on either day 3 (p = 0.95) or day 7 (p = 0.70).
In contrast to previous report in rabbits, we failed to demonstrate the beneficial effects of parenteral zinc supplementation on colon anastomosis repair in a rat model.
为预防结肠吻合口裂开,药物干预应抑制现有黏膜下胶原纤维的降解并加速新胶原分子的合成。锌在胶原代谢中具有多种功能,最近发现其对结肠吻合口修复有益。我们研究了每日腹腔注射锌(2毫克/千克)对左半结肠吻合口生物力学完整性发育的影响。
60只雄性斯普拉格-道利大鼠(中位数245克)在吻合术前1小时开始分别用硫酸锌盐水溶液(n = 30)或仅用盐水(n = 30)进行处理。在术后第3天(n = 30)和第7天(n = 30)测定血清锌水平和吻合口破裂强度。另外10只未处理的动物(277克)测定初始破裂强度或缝线结合能力。
两组联合(n = 30)吻合口的破裂强度在第3天下降了50%(p < 0.001),但与初始吻合口生物力学强度相比,术后第7天恢复。两个干预组的血清锌水平从第3天到第7天也有所升高,且与破裂强度显著相关(r = 0.57,p < 0.001)。虽然在第7天,锌处理组动物的血清锌中位数水平比盐水处理组高14%(p < 0.01),但在第3天(p = 0.95)或第7天(p = 0.70),锌处理组和盐水处理组大鼠的破裂强度没有显著差异。
与之前在兔子身上的报道不同,我们未能在大鼠模型中证明肠外补充锌对结肠吻合口修复的有益作用。