Wu Zhouqiao, Daams Freek, Boersema Geesien S A, Vakalopoulos Konstantinos A, Lam King H, van der Horst Paul H, Kleinrensink Gert-Jan, Jeekel Johannes, Lange Johan F
1 Department of Surgery, Erasmus University Medical Center , Rotterdam, The Netherlands .
Surg Infect (Larchmt). 2014 Dec;15(6):733-8. doi: 10.1089/sur.2013.197.
Colorectal anastomotic leakage (CAL) is the most important complication of colorectal surgery, accounting for one third of post-operative deaths. To prevent it, many interventions have been tested in animal models, mostly rats. However, few of these models have been validated. We aimed to develop a reproducible rat CAL model by creating an anastomosis with insufficient suturing after partial colectomy.
To establish the number of sutures that would create an appropriate leakage rate for research (20%-50%), partial colectomy was performed in 60 Wistar rats using a 12-suture anastomosis in the control group and an anastomosis with insufficient suturing in the experimental group, starting with five sutures. Seven days later, the rats were examined for the occurrence and severity of CAL, the presence of adhesions, and anastomotic bursting pressure. When an acceptable leakage rate was achieved, the experimental and control studies were repeated twice to confirm the adequacy of the chosen technique.
On day 7, five-suture and 12-suture anastomoses had leakage rates of 50% vs. 30%, 44.4% vs. 20%, and 50% vs. 20%, respectively, in the various series. Overall, the five-suture group had a significantly higher CAL rate than did the 12-suture group (48.3% vs. 23.3%; p=0.045). It also had higher CAL severity and more adhesions (p for both<0.05). The bursting pressure of these anastomoses was significantly lower than that in the 12-suture group (116.8±58.9 mm Hg vs. 150.4±50.3 mm Hg; p=0.041).
Anastomosis with five sutures after partial colectomy provides a suitable rat CAL model. Its future applications may help to improve the consistency of CAL studies.
结直肠吻合口漏（CAL）是结直肠手术最重要的并发症，占术后死亡病例的三分之一。为预防该并发症，人们在动物模型（主要是大鼠）中对多种干预措施进行了测试。然而，这些模型中很少有经过验证的。我们旨在通过在部分结肠切除术后进行缝合不足的吻合术来建立一种可重复的大鼠CAL模型。
为确定能产生适合研究的漏出率（20%-50%）的缝合线数量，对60只Wistar大鼠进行部分结肠切除术，对照组采用12针吻合术，实验组采用缝合不足的吻合术，起始为5针。7天后，检查大鼠CAL的发生情况和严重程度、粘连情况以及吻合口破裂压力。当达到可接受的漏出率时，将实验和对照研究重复两次以确认所选技术的适用性。
在第7天，不同系列中5针和12针吻合术的漏出率分别为50%对30%、44.4%对20%、50%对20%。总体而言，5针组的CAL发生率显著高于12针组（48.3%对23.3%；p=0.045）。其CAL严重程度也更高，粘连更多（两者p均<0.05）。这些吻合口的破裂压力显著低于12针组（116.8±58.9毫米汞柱对150.4±50.3毫米汞柱；p=0.041）。
部分结肠切除术后5针吻合术可提供合适的大鼠CAL模型。其未来应用可能有助于提高CAL研究的一致性。
