Department of Surgery, Division of Transplant and Hepatobiliary Surgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
Langenbecks Arch Surg. 2010 Nov;395(8):1039-48. doi: 10.1007/s00423-010-0703-5. Epub 2010 Aug 1.
PURPOSE: Experimental and clinical studies on the sealing of colorectal anastomoses in order to reduce the rate of leakage have previously been performed with divergent results. However, comparatively few studies have been performed on anastomotic healing using a fibrin glue-coated patch. The aim of this experimental basic scientific study in mice was to investigate the effect of fibrin glue-coated collagen patches on the healing process of colonic anastomoses in situations of adverse healing process (technical deficiency and peritonitis). METHODS: Colonic anastomoses were carried out in 206 mice and randomized into six groups (I: complete anastomoses, II: sealed complete anastomoses, III: incomplete anastomoses, IV: sealed incomplete anastomoses, V: complete anastomoses in the presence of bacterial peritonitis, VI: sealed complete anastomoses in the presence of bacterial peritonitis). Tissues from the anastomoses were removed and used for functional, histochemical, molecular, and biochemical investigations. RESULTS: The evaluation of postoperative course data revealed the beneficial effect of additional sealing with a fixed combination of collagen matrix-bound coagulation factors I and IIa (Tachosil(®), Nycomed Austria, Linz) in high-risk experimental anastomotic healing. Sealing incomplete anastomoses resulted in significantly lower lethality and leakage rates, as well as significantly higher bursting pressure values and histopathologic scores. Collagen 1 and 3 expressions and hydroxyproline concentrations are greatly increased with additional sealing in all high-risk anastomoses. CONCLUSIONS: In our current model, we demonstrate that additionally sealing high-risk experimental colonic anastomoses provides a positive effect on the healing process. The effect on the molecular level in particular seems to be essential and requires further experimental studies to evaluate the mechanism.
目的:为了降低吻合口漏的发生率,先前已经进行了许多关于结直肠吻合口密封的实验和临床研究,但其结果存在差异。然而,使用纤维蛋白胶涂层补片来研究吻合口愈合的研究相对较少。本实验旨在通过在实验性基本科学研究中小鼠模型中,研究纤维蛋白胶涂层胶原补片对(技术不足和腹膜炎)不良愈合过程中结肠吻合口愈合过程的影响。
方法:在 206 只小鼠中进行结肠吻合术,并将其随机分为六组(I:完全吻合,II:完全吻合口密封,III:不完全吻合,IV:不完全吻合口密封,V:存在细菌性腹膜炎的完全吻合,VI:存在细菌性腹膜炎的完全吻合口密封)。从吻合部位取出组织,用于功能,组织化学,分子和生化研究。
结果:术后过程数据评估表明,在高风险实验性吻合口愈合中,使用固定的胶原蛋白基质结合凝血因子 I 和 IIa(Tachosil®,Nycomed Austria,Linz)组合进行额外密封具有有益作用。密封不完全吻合可显著降低死亡率和泄漏率,同时显著提高爆裂压力值和组织病理学评分。在所有高风险吻合术中,胶原 1 和 3 的表达和羟脯氨酸浓度均因额外密封而大大增加。
结论:在我们目前的模型中,我们证明了对高风险实验性结肠吻合口进行额外密封对愈合过程具有积极影响。特别是在分子水平上的效果似乎至关重要,需要进一步的实验研究来评估其机制。
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