Wu Zhouqiao, Vakalopoulos Konstantinos A, Boersema Geesien S A, Kroese Leonard F, Lam King H, van der Horst Paul H, Mulder Irene M, Bastiaansen-Jenniskens Yvonne M, Kleinrensink Gert-Jan, Jeekel Johannes, Lange Johan F
Department of Surgery, Erasmus University Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands,
Int J Colorectal Dis. 2014 Dec;29(12):1507-16. doi: 10.1007/s00384-014-2012-x. Epub 2014 Sep 26.
Colorectal anastomoses created in a contaminated environment result in a high leakage rate. This study investigated whether using anastomotic sealants (TissuCol(®), Histoacryl(®) Flex, and Duraseal(®)) prevents leakage in a rat peritonitis model.
Sixty-seven Wistar rats were divided into control and experimental groups (TissuCol, Histoacryl, and Duraseal groups). Peritonitis was induced 1 day before surgery with the cecal ligation puncture model. On day 0, colonic anastomosis was constructed with sutures and then sealed with no adhesive (control group) or one select adhesive (experimental groups). Bursting pressure, abscess formation, and adhesion severity were evaluated on day 3 or day 14. Hematoxylin and eosin staining and immunohistochemical staining for CD4, CD8, CD206, and iNOS were performed.
On day 3, bursting pressures of the TissuCol group (120.1 ± 25.3 mmHg), Histoacryl group (117.3 ± 20.2 mmHg), and Duraseal group (123.6 ± 35.4 mmHg) were significantly higher than the that of the control group (24.4 ± 31.7 mmHg, p < 0.001). Abscesses around the anastomosis were found in the control group (6/7) and Duraseal group (2/9) but not in the TissuCol group or Histoacryl group. A higher number of CD206+ cells (M2 macrophages), a lower number of iNOS+ cells (M1 macrophages), a higher M2/M1 index, and a higher CD4+/CD8+ index were seen at the anastomotic site in all experimental groups compared with the control group on day 3. On day 14, abscesses were only found in the control group. Adhesion severity in the Duraseal group was significantly lower than that in the control group (p = 0.001).
Anastomotic sealing using TissuCol(®), Histoacryl(®) Flex, or Duraseal(®) seems to be an effective and safe option to prevent leakage in contaminated colorectal surgery. The presence of large numbers of anti-inflammatory macrophages seems to be involved in preventing the leakage.
在污染环境中进行的结直肠吻合术导致高渗漏率。本研究调查了使用吻合口密封剂（TissuCol®、Histoacryl® Flex和Duraseal®）是否能在大鼠腹膜炎模型中预防渗漏。
67只Wistar大鼠分为对照组和实验组（TissuCol组、Histoacryl组和Duraseal组）。术前1天采用盲肠结扎穿刺模型诱导腹膜炎。在第0天，用缝线构建结肠吻合口，然后不使用粘合剂（对照组）或使用一种选定的粘合剂（实验组）进行密封。在第3天或第14天评估破裂压力、脓肿形成和粘连严重程度。进行苏木精-伊红染色以及CD4、CD8、CD206和诱导型一氧化氮合酶的免疫组织化学染色。
在第3天，TissuCol组（120.1±25.3 mmHg）、Histoacryl组（117.3±20.2 mmHg）和Duraseal组（123.6±35.4 mmHg）的破裂压力显著高于对照组（24.4±31.7 mmHg，p<0.001）。对照组（6/7）和Duraseal组（2/9）在吻合口周围发现脓肿，而TissuCol组和Histoacryl组未发现。与对照组相比，在第3天所有实验组的吻合口部位可见更多的CD206+细胞（M2巨噬细胞）、更少的诱导型一氧化氮合酶+细胞（M1巨噬细胞）、更高的M2/M1指数和更高的CD4+/CD8+指数。在第14天，仅在对照组发现脓肿。Duraseal组的粘连严重程度显著低于对照组（p = 0.001）。
使用TissuCol®、Histoacryl® Flex或Duraseal®进行吻合口密封似乎是预防污染性结直肠手术中渗漏的一种有效且安全的选择。大量抗炎巨噬细胞的存在似乎与预防渗漏有关。
