From the Departments of Plastic Surgery, Physiology, and Pathology, Marmara University; and the Division of Plastic Surgery, University of Utah.
Plast Reconstr Surg. 2019 Jul;144(1):124-133. doi: 10.1097/PRS.0000000000005708.
Free jejunal flaps are among the most commonly used flaps for esophageal reconstruction. However, ischemia-reperfusion injury caused by warm ischemia seen during transfer limits their use. Iloprost, a prostacyclin analogue, has been shown to reduce ischemia-reperfusion injury in various organs. The authors investigated tissue damage in jejunal flaps with iloprost and ischemic preconditioning and compared the effectiveness of these two modalities.
Thirty-four Sprague-Dawley rats were randomized into five groups: sham, ischemia-reperfusion (control), ischemic preconditioning, iloprost, and ischemic preconditioning plus iloprost. All flaps, except those in the sham group, underwent ischemia for 60 minutes and reperfusion for 2 hours. Flap perfusion was assessed by laser Doppler perfusion monitoring. Histologic sections were scored using the Chiu scoring system. Superoxide dismutase and myeloperoxidase levels were measured spectrophotometrically.
Animals that were administered iloprost and/or underwent ischemic preconditioning had better postischemic recovery of mesenteric perfusion (ischemic preconditioning, 78 percent; iloprost, 83 percent; ischemic preconditioning plus iloprost, 90 percent; versus ischemia-reperfusion, 50 percent; p < 0.05). All intervention groups showed improved histology of jejunal flaps following ischemia-reperfusion injury (ischemic preconditioning, 3; iloprost, 2.3; ischemic preconditioning plus iloprost, 3.2; versus ischemia-reperfusion, 4.7; p < 0.01, p < 0.001, and p < 0.05, respectively). Superoxide dismutase levels were higher in ischemic preconditioning, iloprost plus ischemic preconditioning, and iloprost groups (ischemic preconditioning, 2.7 ± 0.2; ischemic preconditioning plus iloprost, 2.5 ± 0.3; versus ischemia-reperfusion, 1.2 ± 0.1; p < 0.01; iloprost, 2.4 ± 1.1; versus ischemia-reperfusion, 1.2 ± 0.1; p < 0.05). Myeloperoxidase, a marker for neutrophil infiltration, was lower in the iloprost group (iloprost, 222 ± 5; versus ischemia-reperfusion, 291 ± 25; p < 0.05).
This study showed that both iloprost and ischemic preconditioning reduced reperfusion injury in jejunal flaps. Based on histologic results, iloprost may be a novel treatment alternative to ischemic preconditioning.
游离空肠瓣是食管重建中最常用的瓣之一。然而，在转移过程中由于热缺血引起的再灌注损伤限制了它们的使用。前列环素类似物伊洛前列素已被证明可减少各种器官的缺血再灌注损伤。作者研究了伊洛前列素和缺血预处理对空肠瓣的组织损伤，并比较了这两种方法的效果。
34 只 Sprague-Dawley 大鼠随机分为五组：假手术组、缺血再灌注组（对照组）、缺血预处理组、伊洛前列素组和缺血预处理加伊洛前列素组。除假手术组外，所有瓣均经历 60 分钟缺血和 2 小时再灌注。通过激光多普勒灌注监测评估瓣灌注。使用 Chiu 评分系统对组织学切片进行评分。超氧化物歧化酶和髓过氧化物酶水平通过分光光度法测量。
给予伊洛前列素和/或进行缺血预处理的动物肠系膜灌注的缺血后恢复更好（缺血预处理组 78%；伊洛前列素组 83%；缺血预处理加伊洛前列素组 90%；与缺血再灌注组 50%相比；p < 0.05）。所有干预组在缺血再灌注损伤后空肠瓣的组织学均得到改善（缺血预处理组 3；伊洛前列素组 2.3；缺血预处理加伊洛前列素组 3.2；与缺血再灌注组 4.7相比；p < 0.01、p < 0.001 和 p < 0.05，分别）。超氧化物歧化酶水平在缺血预处理、伊洛前列素加缺血预处理和伊洛前列素组中较高（缺血预处理组 2.7 ± 0.2；缺血预处理加伊洛前列素组 2.5 ± 0.3；与缺血再灌注组 1.2 ± 0.1相比；p < 0.01；伊洛前列素组 2.4 ± 1.1；与缺血再灌注组 1.2 ± 0.1相比；p < 0.05）。髓过氧化物酶是中性粒细胞浸润的标志物，在伊洛前列素组中较低（伊洛前列素组 222 ± 5；与缺血再灌注组 291 ± 25相比；p < 0.05）。
本研究表明，伊洛前列素和缺血预处理均减轻了空肠瓣的再灌注损伤。基于组织学结果，伊洛前列素可能是缺血预处理的一种新的治疗选择。
