Cakir Mikail, Yildirim Dogan, Sarac Fatma, Donmez Turgut, Mirapoglu Semih, Hut Adnan, Erozgen Fazilet, Ozer Omer Faruk, Gecer Melih Ozgun, Tigrel Leyla Zeynep, Tas Oguzhan
Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey.
Department of Pediatric surgery, Haseki Training and Research Hospital, Istanbul, Turkey.
J Invest Surg. 2019 Sep;32(6):507-514. doi: 10.1080/08941939.2018.1437486. Epub 2018 Feb 22.
: Acute mesenteric ischemia is a syndrome characterized by sudden onset abdominal pain followed by intestinal necrosis. Morbidity and mortality increase with delayed diagnosis. Even with the latest radiological diagnostic methods, early diagnosis and initiation of treatment can be delayed. Using an experimental model, here we aim to determine the relationship between the laboratory parameters used to detect acute mesenteric ischemia and the duration of irreversible ischemia. : A total of 30 male Wistar albino rats were divided into five groups, all of which underwent general anesthesia: (i) Superior mesenteric artery (SMA) dissection with laparotomy was performed, and blood samples and intestinal segment samples were taken after 2 hr (Sham group); (ii) volvulus of one-third of the small intestines was performed manually by laparotomy, and blood samples and intestinal segment samples were taken after 2 hr (Volvulus group); (iii) SMA was ligated with laparotomy, and blood samples and intestinal segment samples were taken after 2 hr (SMA+ligated 2-hr group); (iv) SMA was ligated with laparotomy, and blood samples and intestinal segment samples were taken after 4 hr (SMA+ligated 4-hr group); and (v) SMA was ligated with laparotomy, and blood samples and intestinal segment samples were taken after 6 hr (SMA+ligated 6-hr group). : The mean lactate dehydrogenase (LDH) activities of the SMA+ligated 2-hr and SMA+ligated 6-hr groups were statistically higher than the control group ( = .004). Compared to the Sham and Volvulus groups, the mean lactate level of the SMA+ligated 6-hr group was significantly higher ( = .004). Compared to the Sham and Volvulus groups, the mean D-dimer levels of the SMA+ligated 4-hr and SMA+ligated 6-hr groups were significantly higher ( = .004 and .003, respectively). By histopathological evaluation, we found that pathological damage increased as the ischemia lengthened. : Mesenteric ischemia leads to an irreversible loss of intestinal perfusion and an increase in parameters of ischemia. Irreversible tissue damage occurs after 4 hr of ischemia and peaks after 6 hr, whereas parameters of ischemia (D-dimer, LDH, and L-Lactate levels) are highest at 2 hr after the onset of ischemia.
急性肠系膜缺血是一种以突发腹痛继而肠坏死为特征的综合征。发病率和死亡率随诊断延迟而增加。即便采用最新的放射学诊断方法，早期诊断和治疗启动仍可能延迟。在此，我们利用实验模型旨在确定用于检测急性肠系膜缺血的实验室参数与不可逆缺血持续时间之间的关系。
总共30只雄性Wistar白化大鼠被分为五组，所有大鼠均接受全身麻醉：（i）通过剖腹术进行肠系膜上动脉（SMA）解剖，并在2小时后采集血样和肠段样本（假手术组）；（ii）通过剖腹术手动对三分之一小肠进行肠扭转，并在2小时后采集血样和肠段样本（肠扭转组）；（iii）通过剖腹术结扎SMA，并在2小时后采集血样和肠段样本（SMA结扎2小时组）；（iv）通过剖腹术结扎SMA，并在4小时后采集血样和肠段样本（SMA结扎4小时组）；以及（v）通过剖腹术结扎SMA，并在6小时后采集血样和肠段样本（SMA结扎6小时组）。
SMA结扎2小时组和SMA结扎6小时组的平均乳酸脱氢酶（LDH）活性在统计学上高于对照组（P = 0.004）。与假手术组和肠扭转组相比，SMA结扎6小时组的平均乳酸水平显著更高（P = 0.004）。与假手术组和肠扭转组相比，SMA结扎4小时组和SMA结扎6小时组的平均D - 二聚体水平显著更高（分别为P = 0.004和P = 0.003）。通过组织病理学评估，我们发现随着缺血时间延长，病理损伤加重。
肠系膜缺血导致肠道灌注不可逆丧失以及缺血参数增加。缺血4小时后发生不可逆组织损伤，并在6小时达到峰值，而缺血参数（D - 二聚体、LDH和L - 乳酸水平）在缺血发作后2小时最高。
