di Bonifácio Marcelo, Parra Rogério Serafim, Almeida Ana Luiza Normanha Ribeiro de, Rocha José Joaquim Ribeiro da, Feres Omar
Department of Surgery and Anatomy, FMRP, USP, Ribeirao Preto, SP, Brazil.
Acta Cir Bras. 2011 Dec;26(6):415-20. doi: 10.1590/s0102-86502011000600002.
To investigate the effects of cirrhosis on colonic anastomosis healing in rats.
Fifty five Wistar male rats were used (23 in the control group and 32 in the cirrhosis group). On the first day of the procedure, the rats in the cirrhosis group underwent double ligation and folding of the common bile duct to induce liver cirrhosis, and the control rats underwent a laparotomy and intestinal manipulation. On the fourteenth and thirty-fifth days, all of the animals were biochemically assessed for serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, bilirubin, total protein, and albumin and for liver histopathology. On the thirty-fifth day, cirrhosis was confirmed. On the twenty-eighth day, all of the animals were subjected to left colon transection and anastomosis. On the seventh day after the colonic anastomosis, the rats were sacrificed and macroscopically evaluated for dehiscence. The region of the colonic anastomosis was removed and subjected to hydroxyproline content measurement, conventional histology, and the immunohistochemical determination of vascular endothelial growth factor (VEGF) and matrix metalloproteinase type 1 (MMP 1).
The biochemical and histopathological examinations confirmed cirrhosis in all of the animals in the cirrhosis group. More deaths occurred after anastomosis in the cirrhosis group (5/25) than in the control group (0/21), and anastomotic dehiscence was more frequent in the cirrhosis group (8/25) than in the control group (0/21). The average hydroxyproline concentration was lower in the cirrhosis group than in the control group. The immunohistochemical studies showed that the average VEGF expression in the cirrhosis group was lower than in the control group, and the average MMP1 expression was higher in the cirrhosis group.
Hepatic cirrhosis leads to increased mortality and colonic anastomotic dehiscence, an increased distance between the mucosal edges of the anastomosis area, and a lower hydroxyproline concentration in the colonic anastomosis; therefore, these conditions are deleterious to healing.
研究肝硬化对大鼠结肠吻合口愈合的影响。
使用55只雄性Wistar大鼠（对照组23只，肝硬化组32只）。在实验第一天，肝硬化组大鼠行胆总管双重结扎及折叠术以诱导肝硬化，对照组大鼠行剖腹术及肠管操作。在第14天和第35天，对所有动物进行血清天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、碱性磷酸酶、胆红素、总蛋白和白蛋白的生化评估以及肝脏组织病理学检查。在第35天，证实肝硬化形成。在第28天，对所有动物进行左半结肠横断及吻合术。在结肠吻合术后第7天，处死大鼠并进行肉眼评估吻合口裂开情况。切除结肠吻合口区并进行羟脯氨酸含量测定、常规组织学检查以及血管内皮生长因子（VEGF）和基质金属蛋白酶1型（MMP 1）的免疫组化测定。
生化和组织病理学检查证实肝硬化组所有动物均形成肝硬化。肝硬化组吻合术后死亡的大鼠（5/25）比对照组（0/21）多，且肝硬化组吻合口裂开比对照组（0/21）更常见（8/25）。肝硬化组平均羟脯氨酸浓度低于对照组。免疫组化研究显示，肝硬化组平均VEGF表达低于对照组，而肝硬化组平均MMP1表达较高。
肝硬化导致死亡率增加和结肠吻合口裂开，吻合口区黏膜边缘间距增大，结肠吻合口羟脯氨酸浓度降低；因此，这些情况不利于愈合。
