Dogan Gul, Dogan Guvenc, Kayir Selcuk, Yagan Ozgur, Hanci Volkan
Department of Pediatric Surgery, Hitit University School of Medicine, Corum, Turkey.
Department of Anesthesiology, Hitit University School of Medicine, Corum, Turkey.
J Surg Res. 2020 Apr;248:123-128. doi: 10.1016/j.jss.2019.12.006. Epub 2019 Dec 30.
After colorectal surgery, anastomotic leakage is a major cause of mortality and morbidity. There are many factors affecting anastomotic leakage. It is known that agents such as neostigmine that is used to reverse neuromuscular blockade have certain effects on anastomosis. In our study, in which we planned to test this hypothesis, we aimed to compare the possible effects of different doses of sugammadex and neostigmine on colon anastomosis strength in a colonic resection anastomosis model in rats.
Forty adult Wistar albino male rats were divided into five groups as control (group C), Sugammadex 16 mg/kg (group SL), sugammadex 96 mg/kg (group SH), neostigmine 0.3 μmol/kg (group NL), and neostigmine 1.5 μmol/kg (group NH). The transverse colons of all rats were resected, and colonic anastomosis was performed. Appropriate drug doses according to the groups were given on the postoperative seventh day, and tissue hydroxyproline (TH) level and anastomotic bursting pressure were measured.
Anastomotic bursting pressure values were statistically significantly different between the groups (P = 0.001). The bursting pressure in group SH was significantly higher compared with group C, group NL, and group NH. The hydroxyproline values were statistically significantly different between the groups (P = 0.015). According to the post hoc test results, the difference was between group SH and group C (P = 0.007). There were no significant differences between the other groups (P > 0.05). There was no significant difference in terms of intra-abdominal adhesion rates between the groups.
In our study, we found that low and high doses of neostigmine had no variable effect on anastomosis, but high dose of sugammadex (96 mg/kg) had an increasing effect on intestinal anastomosis strength.
结直肠手术后，吻合口漏是导致死亡和发病的主要原因。影响吻合口漏的因素众多。已知用于逆转神经肌肉阻滞的新斯的明等药物对吻合口有一定影响。在我们计划验证这一假设的研究中，旨在比较不同剂量的舒更葡糖钠和新斯的明对大鼠结肠切除吻合模型中结肠吻合强度的可能影响。
将40只成年雄性Wistar白化大鼠分为五组，即对照组（C组）、舒更葡糖钠16mg/kg组（SL组）、舒更葡糖钠96mg/kg组（SH组）、新斯的明0.3μmol/kg组（NL组）和新斯的明1.5μmol/kg组（NH组）。切除所有大鼠的横结肠并进行结肠吻合。术后第7天根据分组给予适当的药物剂量，测量组织羟脯氨酸（TH）水平和吻合口破裂压力。
各组间吻合口破裂压力值有统计学显著差异（P = 0.001）。SH组的破裂压力显著高于C组、NL组和NH组。各组间羟脯氨酸值有统计学显著差异（P = 0.015）。根据事后检验结果，差异存在于SH组和C组之间（P = 0.007）。其他组间无显著差异（P > 0.05）。各组间腹腔粘连率无显著差异。
在我们的研究中，发现低剂量和高剂量新斯的明对吻合口无不同影响，但高剂量舒更葡糖钠（96mg/kg）对肠吻合强度有增强作用。
