Ulas Murat, Ozer Ilter, Ercan Metin, Ozogul Yusuf B, Bostanci E Birol, Keklik Tulay Temucin, Turkcu Ummuhani Ozel, Bilgihan Ayse, Akoglu Musa
Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
J Invest Surg. 2009 Nov-Dec;22(6):413-8. doi: 10.3109/08941930903410841.
When used separately, antineoplastic agents and carbon dioxide (CO(2)) pneumoperitoneum have been reported to impair anastomotic healing in experimental animals. However, the effects of their combined use have not been previously investigated. The aim of this study was to investigate the possibility that neoadjuvant chemotherapy with 5-fluorouracil followed by CO(2) pneumoperitoneum would affect the healing of anastomoses in the colon.
Sprague-Dawley rats (n = 48) were given 5-fluorouracil (20 mg/kg/day) for 5 days, and were then assigned to one of the three groups. Prior to surgery, the control group received no pneumoperitoneum. The other two groups received pneumoperitoneum at 6 and 12 mmHg, respectively, for 2 hr. The large intestine was transected and anastomosis was performed via median laparotomy. On postoperative days 3 and 7, relaparotomy was performed in half of the rats in each group. From the colon, a segment including the anastomosis was excised. Tissue hydroxyproline levels were measured. For histological evaluation, the Verhofstad scale was modified and used.
No significant differences in hydroxyproline levels were seen across the groups on postoperative days 3 or 7. However, by postoperative day 7, polymorphonuclear leukocytes and necrosis in the 6-mmHg group had decreased markedly, and granulation had improved.
Overall, these findings suggest that preoperative 5-fluorouracil therapy followed by pneumoperitoneum at 6 or 12 mmHg does not impair anastomotic healing.
据报道，抗肿瘤药物和二氧化碳（CO₂）气腹单独使用时会损害实验动物的吻合口愈合。然而，它们联合使用的效果此前尚未得到研究。本研究的目的是探讨5-氟尿嘧啶新辅助化疗后行CO₂气腹是否会影响结肠吻合口的愈合。
将48只Sprague-Dawley大鼠给予5-氟尿嘧啶（20mg/kg/天），持续5天，然后分为三组。手术前，对照组不行气腹。另外两组分别在6mmHg和12mmHg下行气腹2小时。经正中剖腹术切断大肠并进行吻合。术后第3天和第7天，每组半数大鼠再次剖腹。从结肠切除包括吻合口的一段。测量组织羟脯氨酸水平。为进行组织学评估，对Verhofstad评分进行修改并使用。
术后第3天或第7天，各组间羟脯氨酸水平无显著差异。然而，到术后第7天，6mmHg组的多形核白细胞和坏死明显减少，肉芽组织有所改善。
总体而言，这些发现表明术前给予5-氟尿嘧啶治疗后行6mmHg或12mmHg气腹不会损害吻合口愈合。
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