Oikonomakis Ioannis, Horer Tal M, Skoog Per, Nilsson Kristofer F, Jansson Kjell
Colorectal Unit, Department of General Surgery, Örebro University Hospital, Örebro, Sweden.
Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Ann Coloproctol. 2020 Dec;36(6):374-381. doi: 10.3393/ac.2019.09.30.1. Epub 2020 Feb 25.
Anastomotic leakage (AL) is the most dreaded complication in rectal surgery. It has a great impact on postoperative morbidity and mortality. This animal model, in which we have studied postoperative metabolic and inflammatory changes, is designed to imitate an AL.
Twelve pigs were randomized into 2 groups. In the experimental group, an iatrogenic rectal perforation was performed, with the control group having a sham operation. The 2 groups were followed for 10 hours after operation with regard to vital parameters, arterial lactate, and cytokines interleukin (IL) 1, IL6, and IL10 in the blood and intraperitoneally. Intraperitoneal microdialysis analyses of glucose, lactate, glycerol, and pyruvate were performed and the lactate/pyruvate ratio was calculated.
Glucose levels were lower in the experimental group after 4 hours. After 7 hours, lactate and lactate/pyruvate ratio was higher in the experimental group. At the same time intraperitoneal cytokines IL6 and IL10 were higher in the experimental group. Blood samples showed higher IL6 after 7 hours in the experimental group.
In this study, several significant differences between the groups in metabolic and inflammatory values were detected. Further clinical studies are recommended to evaluate the importance of intraperitoneal metabolic and inflammatory analyses as a diagnostic tool for early identification of an AL.
吻合口漏（AL）是直肠手术中最可怕的并发症。它对术后发病率和死亡率有很大影响。本动物模型旨在模拟吻合口漏，我们已在其中研究了术后代谢和炎症变化。
将12头猪随机分为2组。实验组进行医源性直肠穿孔，对照组进行假手术。术后对两组进行10小时的观察，监测生命体征参数、动脉血乳酸以及血液和腹腔内的细胞因子白细胞介素（IL）-1、IL-6和IL-10。进行腹腔内葡萄糖、乳酸、甘油和丙酮酸的微透析分析，并计算乳酸/丙酮酸比值。
4小时后实验组葡萄糖水平较低。7小时后，实验组的乳酸和乳酸/丙酮酸比值较高。同时，实验组腹腔内细胞因子IL-6和IL-10较高。实验组血液样本在7小时后IL-6较高。
在本研究中，检测到两组在代谢和炎症值方面存在若干显著差异。建议进一步开展临床研究，以评估腹腔内代谢和炎症分析作为早期识别吻合口漏诊断工具的重要性。
