Department of General Surgery, Medipol University Faculty of Medicine, İstanbul-Turkey.
Department of General Surgery, Memorial Hospital, İstanbul-Turkey.
Ulus Travma Acil Cerrahi Derg. 2021 Jan;27(1):1-8. doi: 10.14744/tjtes.2020.41624.
Anastomotic leakages and adhesions after gastrointestinal tract surgery are still a significant cause of morbidity and mortality. The rate of anastomotic leakage is 3%-8%, whereas the mortality from leakage is over 30%. Intra-abdominal sepsis is a well-known cause of anastomotic leakage. In addition, intra-abdominal adhesion is a major cause of hospital admissions and reoperations and is associated with morbidity and mortality. In this study, we aimed to investigate the effects of a polyurethane membrane on anastomotic healing and intra-abdominal adhesions.
This study used 32 Wistar albino rats divided into four groups. Standard resection of left colon 2 cm above the peritoneal reflection and colonic anastomosis were performed after causing abdominal sepsis through caecal ligation and perforation. The control groups (1 and 3) received no further treatment. The experimental groups (2 and 4) received the polyurethane membrane around the colonic anastomosis. Burst pressure, hydroxyproline, interleukin-6 (IL-6), nitric oxide (NO), tissue plasminogen activator (tPA), and tumor necrosis factor-alpha (TNF-α) levels were measured, and histopathological characteristics of the anastomosis were analyzed after re-laparotomy. Moreover, adhesion scores were measured.
No statistically significant differences were found in the mean burst pressure levels between sacrificed animals on days three and five (p=0.259, p=0.177). When all the groups were compared, no significant difference was observed in the hydroxyproline, NO, and IL-6 levels (p=0.916, p=0.429, p=0.793, p=0.332, p=0.400, p=0.317). However, in groups 2 and 4, the tPA levels were significantly increased by Opsite therapy (p=0.001, p=0.003), and a statistically significant difference was observed in the adhesion scores (p<0.035). Groups 2 and 4 had significantly lower adhesion scores than groups 1 and 3.
We found that Opsite therapy had no positive or negative effects on histopathological and biochemical healing in the experimental septic colon anastomosis model. However, the perianastomotic application of polyurethane membrane effectively decreased the intra-abdominal adhesions.
胃肠道手术后的吻合口漏和粘连仍然是发病率和死亡率的重要原因。吻合口漏的发生率为 3%-8%，而漏的死亡率超过 30%。腹腔内脓毒症是吻合口漏的一个已知原因。此外，腹腔内粘连是住院和再次手术的主要原因，并与发病率和死亡率有关。在这项研究中，我们旨在研究聚氨酯膜对吻合口愈合和腹腔内粘连的影响。
本研究使用 32 只 Wistar 白化大鼠，分为四组。通过盲肠结扎和穿孔引起腹腔内脓毒症后，进行左结肠距腹膜反射 2cm 处的标准切除和结肠吻合。对照组（1 组和 3 组）未进行进一步治疗。实验组（2 组和 4 组）在结肠吻合处周围使用聚氨酯膜。测量爆裂压力、羟脯氨酸、白细胞介素-6（IL-6）、一氧化氮（NO）、组织型纤溶酶原激活物（tPA）和肿瘤坏死因子-α（TNF-α）水平，并在再次剖腹手术后分析吻合处的组织病理学特征。此外，还测量了粘连评分。
在第 3 天和第 5 天处死动物时，平均爆裂压力水平无统计学差异（p=0.259，p=0.177）。当比较所有组时，羟脯氨酸、NO 和 IL-6 水平无显著差异（p=0.916，p=0.429，p=0.793，p=0.332，p=0.400，p=0.317）。然而，Opsite 治疗使 2 组和 4 组的 tPA 水平显著升高（p=0.001，p=0.003），粘连评分有统计学差异（p<0.035）。2 组和 4 组的粘连评分明显低于 1 组和 3 组。
我们发现，Opsite 治疗对实验性脓毒症结肠吻合模型的组织病理学和生化愈合没有积极或消极的影响。然而，聚氨酯膜在吻合口周围的应用有效地减少了腹腔内粘连。
