Department of Surgery, Elazığ Training and Research Hospital, Elazığ-Turkey.
Department of Surgery, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş-Turkey.
Ulus Travma Acil Cerrahi Derg. 2021 Mar;27(2):167-173. doi: 10.14744/tjtes.2020.46682.
The present study aims to evaluate the use of the chlorhexidine gluconate and metronidazole impregnated compresses concerning anastomosis safety in the left colonic anastomosis in the presence of peritonitis.
This study was conducted on 21 Wistar-Albino-rats divided into three equal groups. After median laparotomy, the whole layer of the left colon was cut 2 cm over the pelvic peritoneum. The faeces were spread around the injury for fecal contamination. Then, fasia and skin were closed with 3/0 silk. After one day period, relaparatomy was performed. The abdomen was cleared isotonic sodium chloride with impregnated material before starting colonic anastomosis in the first group and then double layer colonic anastomosis was performed. In the second Group-II, abdomen was cleared with the metronidazole impregnated compresses then double layer colonic anastomosis was performed. In the group-III, abdomen was cleared with the chlorhexidine gluconate impregnated compresses then double layer colonic anastomosis was performed. Tissue hydroksiproline levels and anastomosis bursting pressures were measured and histopathologic findings on the anastomosis line were evaluated on the postoperative tenth day by performing relaparatomy.
The highest anastomosis bursting pressure was found in Group-III (p<0.05). The highest tissue hydroksiproline level was found in Group-III (p<0.005 Group I-III, Group II-III). When histopathologic findings were evaluated by comparing the three groups in this study, the healing of the intestine tissue score was statistically insignificant between group-II and III, for both group-II and III, healing score was statistically significant higher than Group-I (p<0.05 Group I-III and Group I-II).
Cleaning the abdomen before the anastomosis using antibacterial soaked material increased resection safety in the presence of peritonitis and anastomosis safety in primary anastomosis.
本研究旨在评估聚维酮碘和甲硝唑浸渍敷贴在腹腔感染时行左半结肠吻合术的吻合安全性。
本研究纳入 21 只 Wistar-Albino 大鼠，随机分为三组。剖腹后，在骨盆腹膜上方 2cm 处横切整个左半结肠。粪便散布在损伤周围以造成粪便污染。然后用 3/0 丝线缝合筋膜和皮肤。一天后再次剖腹。在第一组中，先用浸渍材料的生理盐水冲洗腹部，然后行双层结肠吻合术。在第二组中，先用甲硝唑浸渍敷贴冲洗腹部，然后行双层结肠吻合术。在第三组中，先用聚维酮碘浸渍敷贴冲洗腹部，然后行双层结肠吻合术。术后第十天再次剖腹，测量组织羟脯氨酸水平和吻合口爆裂压，并观察吻合口的组织病理学变化。
第三组的吻合口爆裂压最高（p<0.05）。第三组的组织羟脯氨酸水平最高（p<0.005，组间比较）。在组织病理学评分方面，三组之间差异有统计学意义（p<0.05），但组间两两比较无统计学意义。
在吻合前使用抗菌浸渍材料冲洗腹部可提高腹腔感染时的切除安全性和一期吻合的安全性。
