Uludag Mehmet, Citgez Bulent, Ozkaya Ozay, Yetkin Gurkan, Ozcan Omer, Polat Nedim, Isgor Adnan
Second Department of General Surgery, Sisli Etfal Training and Research Hospital, Sisli, Istanbul, Turkey.
Int J Colorectal Dis. 2009 Jul;24(7):809-17. doi: 10.1007/s00384-009-0691-5. Epub 2009 Mar 12.
This study was aimed at examining whether or not the addition of amniotic membrane to a sutured colonic anastomosis improves its healing.
Ninety female Sprague Dawley rats were used in the study. Ten served as controls for bursting pressure measurement, while the other 80 animals were divided into four groups: Anastomosis group (NA), high-risk anastomosis group (HRA), anastomosis plus amniotic membrane group (NA-AM), and high-risk anastomosis plus amniotic membrane group (HRA-AM). The last two groups had amniotic membrane covering their anastomoses. Anastomotic evaluation was carried out on the third (NA3, HRA3, NA-AM3, and HRA-AM3, respectively) and seventh (NA7, HRA7, NA-AM7, and HRA-AM7, respectively) postoperative days. The main outcome measures were gross anastomotic healing, adhesion formation, mechanical strength, hydroxyproine content, and parameters of histopathological healing.
Anastomotic dehiscence rate was 66.7%, 40%, 20%, and 10% in group HRA7, HRA3, NA7, and NA3, respectively. However, there was no significant difference between groups regarding the dehiscence rate. The adhesion scores were significantly higher in groups NA3 and HRA3 compared with groups NA-AM3 and HRA-AM3, respectively (p < 0.05, p < 0.001). Bursting pressure was significantly higher in groups with amniotic membrane compared without amniotic membrane (p < 0.05, for all comparison). Inflammatory cell infiltration was significantly lower in groups with amniotic membrane compared with groups without amniotic membrane (p < 0.05, for all both comparisons). Neoangiogenesis was significantly higher in the NA-AM3 and HRA-AM3 groups compared with the NA3 (p < 0.01) and HRA3 (p < 0.05) groups, respectively. Fibroblast activity was significantly higher in groups NA-AM3 and NA-AM7 compared with groups NA3 (p < 0.05) and NA7 (p < 0.05), respectively. Collagen deposition and hydroxyproline concentrations were significantly higher in groups with amniotic membrane compared with groups without amniotic membrane (p < 0.05, for all both comparisons).
The covering of both normal and high-risk colonic anastomoses with amniotic membrane provides a beneficial effect over conventional suturing of healing.
本研究旨在探讨在缝合的结肠吻合术中添加羊膜是否能改善其愈合情况。
本研究使用了90只雌性Sprague Dawley大鼠。10只作为测定破裂压力的对照组，其余80只动物分为四组：吻合术组（NA）、高风险吻合术组（HRA）、吻合术加羊膜组（NA - AM）和高风险吻合术加羊膜组（HRA - AM）。后两组的吻合口覆盖有羊膜。分别在术后第3天（分别为NA3、HRA3、NA - AM3和HRA - AM3）和第7天（分别为NA7、HRA7、NA - AM7和HRA - AM7）进行吻合口评估。主要观察指标包括大体吻合口愈合情况、粘连形成、机械强度、羟脯氨酸含量以及组织病理学愈合参数。
HRA7组、HRA3组、NA7组和NA3组的吻合口裂开率分别为66.7%、40%、20%和10%。然而，各组之间的裂开率无显著差异。与NA - AM3组和HRA - AM3组相比，NA3组和HRA3组的粘连评分显著更高（p < 0.05，p < 0.001）。与未使用羊膜的组相比，使用羊膜的组的破裂压力显著更高（所有比较中p < 0.05）。与未使用羊膜的组相比，使用羊膜的组的炎症细胞浸润显著更低（所有两个比较中p < 0.05）。与NA3组（p < 0.01）和HRA3组（p < 0.05）相比，NA - AM3组和HRA - AM3组的新生血管形成显著更高。与NA3组（p < 0.05）和NA7组（p < 0.05）相比，NA - AM3组和NA - AM7组的成纤维细胞活性显著更高。与未使用羊膜的组相比，使用羊膜的组的胶原蛋白沉积和羟脯氨酸浓度显著更高（所有两个比较中p < 0.05）。
用羊膜覆盖正常和高风险结肠吻合口比传统缝合愈合具有有益效果。
