氟尿嘧啶、博来霉素和顺铂化疗对大鼠结直肠吻合口愈合的影响。

Ann Ital Chir. 2020;91:552-562.

PURPOSE

Chemotherapeutic factors are known to affect healing on the postoperative patient. The aim of the present experimental study was to evaluate the effect of intraperitoneal infusion of 5-fluorouracil, bleomycin and cisplatin on the healing of colonic anastomoses in rats.

METHODS

Forty Albino-Wistar male rats were randomly divided into two groups, a control and a chemotherapy (CT) group. In both, an end-to-end colonic anastomosis was performed. collagen, In the control group, 2cc saline was administered intraperitoneally during the operation and daily postoperatively until the sacrifice. In the CT group, rats were administered a solution of 5-fluorouracil (20mg/kg b.w.), bleomycin (4mg/kg b.w.) and cisplatin (0.7 mg/kg b.w.) in an amount of 2cc intraperitoneal intraoperatively and afterwards daily postoperatively until the seventh postoperative day when they were sacrificed. At sacrifice, adhesion presence was calculated and the anastomoses were resected and macroscopically examined. Bursting pressures were calculated and histological features were graded. Hydroxyproline concentrations were evaluated.

RESULTS

No deaths or wound infections were observed until sacrifice. Bodyweight was significantly decreased in the CT group (p=0.005). Bursting pressures (p=0.001) were significantly lower in the chemotherapy group, whereas adhesions were significantly increased (p=0.001). Hydroxyproline concentrations were not significantly different (p=0.401). All histological parameters appeared significantly decreased in the CT group: inflammation (p<0.008), neoangiogenesis (p<0.001), and fibroblast activity (p=0.001) and collagen deposition (p<0.001).

CONCLUSION

The use of chemotherapeutic agents had negative effects on the healing process of colonic anastomosis in rats. The decreased inflammatory response depicts in more frequent anastomotic dehiscence, ruptures and bodyweight loss postoperatively.

KEY WORDS

Adhesion, Bursting pressure, Collagen, Hydroxyproline, Inflammation, Neoangiogenesis.

目的

已知化疗因素会影响术后患者的愈合。本实验研究的目的是评估腹腔内输注氟尿嘧啶、博来霉素和顺铂对大鼠结肠吻合口愈合的影响。

方法

将 40 只白化 Wistar 雄性大鼠随机分为对照组和化疗（CT）组。在两组中，均进行端端结肠吻合术。在对照组中，术中给予腹腔内 2cc 生理盐水，术后每天给予直至处死。在 CT 组中，大鼠术中给予氟尿嘧啶（20mg/kg b.w.）、博来霉素（4mg/kg b.w.）和顺铂（0.7mg/kg b.w.）的溶液 2cc，术后每天给予直至第 7 天处死。处死时计算粘连存在情况，并切除吻合口进行宏观检查。计算爆裂压并对组织学特征进行分级。评估羟脯氨酸浓度。

结果

直至处死，未观察到死亡或伤口感染。CT 组体重明显下降（p=0.005）。化疗组的爆裂压（p=0.001）显著降低，而粘连显著增加（p=0.001）。羟脯氨酸浓度无显著差异（p=0.401）。CT 组所有组织学参数均明显降低：炎症（p<0.008）、新生血管形成（p<0.001）、成纤维细胞活性（p=0.001）和胶原蛋白沉积（p<0.001）。