Moslemi Sam, Joraghi Sajjad Ahmadi, Roshanravan Reza, Ghahramani Leila, Mohammadianpanah Mohammad, Hosseinzadeh Masood, Rezaianzadeh Abbas, Hussein Ahmed Mohammed Ali, Najibpour Neda, Hosseini Seyed Vahid
Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of General Surgery Al Hussein Teaching Hospital, Kerbala, Iraq.
Iran J Med Sci. 2016 Nov;41(6):501-506.
Radiotherapy is one of the most important factors which results in negative effects on wound healing and increases anastomosis leakage. Diverting loop ileostomy has been usually performed after colorectal anastomosis in cases of colorectal cancer with a history of neoadjuvant radiotherapy to decrease the chance of leakage. Considering the side effects of diverting loop ileostomy, the objective of the present study is to investigate the effect of human amniotic membrane (HAM) on colorectal anastomosis leakage after neo-adjuvant radiotherapy.
In this experimental animal study, 20 crossbreed rabbits were randomly divided into two groups (case group: 13 rabbits, control group: 7 rabbits) after receiving an equal dose of external beam radiation. Four weeks after irradiation, resection of 4 cm of colorectal segment and end-to-end single layer anastomosis were conducted. In the case group, a 2×2 cm wrap of HAM applied around the site of anastomosis. Eight weeks later, all the survived rabbits were sacrificed. A segment of anastomotic sites was resected in all expired and survived rabbits and sent for pathological evaluation. Mann-Whitney U Test (SPSS for Windows, Ver. 16, Chicago, IL) was applied to analyze healing scores between the two groups.
Due to anastomosis dehiscence, 5 rabbits expired in the control group, but all the 13 rabbits (case group) survived after 8 weeks and showed no leakage. In addition, pathological evaluation revealed significant epithelialization and neovascularization in the case group. Statistically, healing score was higher in the case group rather than the control group (P<0.001).
To prevent post irradiation colorectal anastomosis leakage, the use of HAM might play a significant role and a feasible technical approach.
放射治疗是对伤口愈合产生负面影响并增加吻合口漏的最重要因素之一。对于有新辅助放疗史的结直肠癌患者，在行结直肠吻合术后通常会进行转流性回肠造口术以降低漏的发生率。考虑到转流性回肠造口术的副作用，本研究的目的是探讨人羊膜（HAM）对新辅助放疗后结直肠吻合口漏的影响。
在本实验动物研究中，20只杂交兔在接受同等剂量的外照射后被随机分为两组（病例组：13只兔，对照组：7只兔）。照射4周后，切除4 cm的结直肠段并进行端端单层吻合。在病例组，将一块2×2 cm的HAM包裹在吻合部位周围。8周后，处死所有存活的兔。对所有死亡和存活兔的一段吻合部位进行切除并送去做病理评估。应用Mann-Whitney U检验（SPSS for Windows，版本16，伊利诺伊州芝加哥）分析两组之间的愈合评分。
由于吻合口裂开，对照组有5只兔死亡，但病例组的13只兔在8周后全部存活且无漏出。此外，病理评估显示病例组有明显的上皮化和新血管形成。统计学上，病例组的愈合评分高于对照组（P<0.001）。
为预防放疗后结直肠吻合口漏，使用HAM可能发挥重要作用且是一种可行的技术方法。
