Martinou Eirini, Drakopoulou Stamatoula, Aravidou Eftychia, Sergentanis Theodore, Kondi-Pafiti Agathi, Argyra Eriphyli, Voros Dionysios, Fragulidis Georgios P
Department of Surgery, Western Sussex Hospitals - St Richard's, Health Education Kent, Surrey and Sussex, Chichester, UK; Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
J Surg Res. 2018 Mar;223:165-173. doi: 10.1016/j.jss.2017.11.012. Epub 2017 Nov 28.
Current evidence regarding the effects of selective cyclooxygenase inhibitors on gastrointestinal anastomoses is controversial. An experimental randomized control study was conducted in our institution to histopathologically evaluate the consequences of parecoxib, on intestinal and abdominal wound healing.
Twenty-four adult Wistar rats underwent laparotomy, ascending colon transection, and hand-sewn anastomosis. They were randomized to receive either parecoxib (0.5 mg/kg twice daily) or 0.9% normal saline by intraperitoneal injection postoperatively. Animals were euthanatized either on the third or the seventh postoperative day. Semiquantitative methods were used to evaluate both intestinal and abdominal wounds for inflammatory cell composition, angiogenesis, fibroblasts, granular tissue, collagen deposition, epithelization, and presence of necrosis, exudate, and abscess formation. Results are presented as (parecoxib: median [IQR] versus control: median [IQR], P-value).
No macroscopic anastomotic leakage or wound dehiscence was observed. Intestinal anastomoses in the parecoxib group, showed significantly decreased epithelization (2 [1] versus 3 [1], [P = 0.004]) and collagen deposition (2 [0] versus 3 [1], [P = 0.041]). No difference was observed in angiogenesis (3 [1] versus 2.5 [1], [P = 0.158]). Abdominal wall specimens appeared to demonstrate decreased epithelization (2 [2] versus 4 [0.5], [P = 0.0004]) in the treatment group. No difference between the two groups was identified regarding collagen deposition (2.5 [1] versus 2 [0.5], [P = 0.280]) and angiogenesis (2.5 [1] versus 2 [1], [P = 0.633]). Necrosis was significantly more present in the parecoxib group in both specimen types, (3.5 [1] versus 2.5 [1], [P = 0.017]) and (3 [1] versus 1 [0.5], [P < 0.0001]).
The present study shows that despite the absence of clinical adverse effects, parecoxib can impair anastomotic and abdominal wound healing on a histopathological level.
目前关于选择性环氧化酶抑制剂对胃肠道吻合口影响的证据存在争议。我们机构进行了一项实验性随机对照研究，以组织病理学评估帕瑞昔布对肠道和腹部伤口愈合的影响。
24只成年Wistar大鼠接受剖腹手术、升结肠横断和手工缝合吻合术。术后通过腹腔注射将它们随机分为接受帕瑞昔布（0.5mg/kg，每日两次）或0.9%生理盐水的组。在术后第三天或第七天对动物实施安乐死。采用半定量方法评估肠道和腹部伤口的炎症细胞组成、血管生成、成纤维细胞、颗粒组织、胶原沉积、上皮形成以及坏死、渗出物和脓肿形成的情况。结果以（帕瑞昔布：中位数[四分位间距]对对照组：中位数[四分位间距]，P值）表示。
未观察到明显的吻合口漏或伤口裂开。帕瑞昔布组的肠道吻合口显示上皮形成显著减少（2[1]对3[1]，[P = 0.004]）和胶原沉积减少（2[0]对3[1]，[P = 0.041]）。血管生成方面未观察到差异（3[1]对2.5[1]，[P = 0.158]）。治疗组腹壁标本显示上皮形成减少（2[2]对4[0.5]，[P = 0.0004]）。两组在胶原沉积（2.5[1]对2[0.5]，[P = 0.280]）和血管生成（2.5[1]对2[1]，[P = 0.633]）方面未发现差异。在两种标本类型中，帕瑞昔布组的坏死均明显更多，（3.5[1]对2.5[1]，[P = 0.017]）和（3[1]对1[0.5]，[P < 0.0001]）。
本研究表明，尽管没有临床不良反应，但帕瑞昔布在组织病理学水平上会损害吻合口和腹部伤口的愈合。
