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低分子量肝素会损害吻合口伤口愈合吗?

Does low molecular weight heparin impair anastomotic wound healing?

作者信息

Ergul Emre, Ozgun Yigit Mehmet, Kiyak Gulten, Barit Ozgun Gonca, Korukluoglu Birol, Kusdemir Ahmet

机构信息

General Surgery Department, Ankara Ataturk Teaching and Research Hospital, Askaabat Cad. Eser Sitesi B Blok 3.Giris, Daire:11 Bahcelievler, 06490, Ankara, Turkey.

出版信息

J Gastrointest Surg. 2009 Apr;13(4):798-803. doi: 10.1007/s11605-008-0771-9. Epub 2008 Dec 13.

DOI:10.1007/s11605-008-0771-9
PMID:19083069
Abstract

BACKGROUND

Enoxaparin is an important molecule which had been using in prophylaxis and treatment of deep venous thrombosis. Also, it is showed that it prevents postsurgical peritoneal adhesions in rats. It is aimed to evaluate its effects on gastrointestinal wound healing.

METHODS

Thirty Wistar albino rats were divided into three groups as control, subcutan, and intraperitoneal enoxaparin groups. Left colon anastomoses were performed. On postoperative seventh day, anastomotic healing was evaluated by measuring anastomotic bursting pressure, tissue hydroxyproline levels, and histopathological examination.

RESULTS

The anastomotic bursting pressure was highest in subcutan enoxaparin group (p < 0.001), intraperitoneal enoxaparin group (p < 0.01) came the second, and the control group has the worst value. The hydroxyproline results were found nearly similar to the bursting pressure values (subcutan (p < 0.001) > intraperitoneal (p < 0.05) > control). Neovascularization in subcutan group (p < 0.001) has a statistically significant difference to other groups.

CONCLUSION

Enoxaparin did not interfere with colonic anastomotic resistance but improved the intestinal wound healing.

摘要

背景

依诺肝素是一种重要的分子,已用于预防和治疗深静脉血栓形成。此外,研究表明它可预防大鼠术后腹膜粘连。本研究旨在评估其对胃肠道伤口愈合的影响。

方法

将30只Wistar白化大鼠分为三组,即对照组、皮下注射依诺肝素组和腹腔注射依诺肝素组。进行左结肠吻合术。术后第7天,通过测量吻合口破裂压力、组织羟脯氨酸水平和组织病理学检查来评估吻合口愈合情况。

结果

皮下注射依诺肝素组的吻合口破裂压力最高(p < 0.001),腹腔注射依诺肝素组次之(p < 0.01),对照组最差。羟脯氨酸结果与破裂压力值相近(皮下注射组(p < 0.001)>腹腔注射组(p < 0.05)>对照组)。皮下注射组的新生血管形成(p < 0.001)与其他组相比有统计学显著差异。

结论

依诺肝素不影响结肠吻合口的抗张强度,但可促进肠道伤口愈合。

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本文引用的文献

1
A probabilistic cost-effectiveness analysis of enoxaparin versus unfractionated heparin for the prophylaxis of deep-vein thrombosis following major trauma.依诺肝素与普通肝素预防严重创伤后深静脉血栓形成的概率性成本效益分析。
Can J Clin Pharmacol. 2007 Summer;14(2):e215-26. Epub 2007 Jun 6.
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Peritoneal adhesions: facing the enemy.腹膜粘连:直面敌人。
Int J Surg. 2008 Jun;6(3):253-60. doi: 10.1016/j.ijsu.2007.05.010. Epub 2007 Jun 3.
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An evaluation of low molecular weight heparin and hyperbaric oxygen treatment in the prevention of intra-abdominal adhesions and wound healing.
低分子量肝素与高压氧治疗预防腹腔内粘连及促进伤口愈合的评估
Am J Surg. 2005 Feb;189(2):155-60. doi: 10.1016/j.amjsurg.2004.11.002.
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Intraperitoneal and subcutaneous pharmacokinetics of low molecular weight heparin in continuous ambulatory peritoneal dialysis patients.
Adv Perit Dial. 2003;19:28-30.
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Invited research review: Cell-matrix interactions in the gut epithelium.特邀研究综述:肠道上皮中的细胞-基质相互作用
Surgery. 2003 Mar;133(3):263-7. doi: 10.1067/msy.2003.24.
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Anastomotic healing in the rat colon: comparison between a radiological method, breaking strength and bursting pressure.大鼠结肠吻合口愈合:放射学方法、抗张强度和爆破压力之间的比较
Int J Colorectal Dis. 2002 Nov;17(6):420-5. doi: 10.1007/s00384-002-0392-9. Epub 2002 Apr 16.
7
Effect of heparin on tissue binding activity of fibroblast growth factor and heparin-binding epidermal growth factor in experimental colitis in rats.肝素对大鼠实验性结肠炎中成纤维细胞生长因子和肝素结合表皮生长因子组织结合活性的影响
Pediatr Res. 2002 May;51(5):635-40. doi: 10.1203/00006450-200205000-00015.
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Heparin therapy for ulcerative colitis? Effects and mechanisms.
Eur J Gastroenterol Hepatol. 2001 Apr;13(4):449-56. doi: 10.1097/00042737-200104000-00026.
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Thromboprophylaxis using a low molecular weight heparin delays fracture repair.
Clin Orthop Relat Res. 2000 Dec(381):278-89. doi: 10.1097/00003086-200012000-00032.
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Platelet-derived growth factor and epidermal growth factor play a major role in human colonic fibroblast repair activities.血小板衍生生长因子和表皮生长因子在人类结肠成纤维细胞修复活动中起主要作用。
Eur Surg Res. 2000;32(3):191-6. doi: 10.1159/000008762.