Department of Anatomy, Inonu University, Malatya-Türkiye.
Flora Transplantation Institute, Istanbul-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2023 Jun;29(6):647-654. doi: 10.14744/tjtes.2023.92324.
Duodenal ulcer perforation is a serious condition. A number of methods have been defined and used in surgical treatment. In this study, it was aimed to compare the effectiveness of 'primary repair' and 'drain placement without repair' methods in duodenal perforations using an animal model.
Three equivalent groups of ten rats each were formed. Perforation was created in the duodenum in the first (primary repair/sutured group) and the second group (drain placement without repair/sutureless drainage group). In the first group, the per-foration was repaired with sutures. In the second group, only a drain was placed in the abdomen without sutures. In the third group (control group), only laparotomy was performed. Neutrophil count, sedimentation, serum C-reactive protein (CRP), serum total an-tioxidant capacity (TAC), serum total thiol, serum native thiol, and serum myeloperoxidase (MPO) analyses were performed on animal subjects in the pre-operative period and on the post-operative 1st and 7th days. Histological and immunohistochemical (transforming growth factor-beta 1 [TGF-β1]) analyzes were performed. Blood analysis, histological, and immunohistochemical findings obtained from the groups were compared statistically.
There was no significant difference between the first and second groups, except for the TAC on the post-operative 7th day and MPO values on the post-operative 1st day (P>0.05). Although tissue healing was more pronounced in the second group than in the first group, there was no significant difference between the groups (P>0.05). TGF-β1 immunoreactivity observed in the second group was found to be significantly higher than in the first group (P<0.05).
We think that the sutureless drainage method is as effective as the primary repair method in the treatment of duo-denal ulcer perforation and can be safely applied as an alternative to the primary repair method. However, further studies are needed to fully determine the efficacy of the sutureless drainage method.
十二指肠溃疡穿孔是一种严重的疾病。已经定义并使用了许多方法来进行外科治疗。在这项研究中，我们旨在通过动物模型比较“一期修复”和“无修复引流”方法在十二指肠穿孔中的疗效。
将 30 只大鼠分为三组，每组 10 只。在第一组（一期修复/缝合组）和第二组（无修复引流/无缝合引流组）的十二指肠上创建穿孔。在第一组中，用缝线修复穿孔。在第二组中，仅在腹部放置引流管而不缝合。在第三组（对照组）中，仅进行剖腹手术。在术前、术后第 1 天和第 7 天对动物进行中性粒细胞计数、沉降率、血清 C 反应蛋白（CRP）、血清总抗氧化能力（TAC）、血清总巯基、血清天然巯基和血清髓过氧化物酶（MPO）分析。进行组织学和免疫组织化学（转化生长因子-β1[TGF-β1]）分析。统计比较各组的血液分析、组织学和免疫组织化学结果。
除了术后第 7 天的 TAC 和术后第 1 天的 MPO 值外，第一组和第二组之间没有显著差异（P>0.05）。虽然第二组的组织愈合比第一组更明显，但两组之间没有显著差异（P>0.05）。第二组 TGF-β1 免疫反应性明显高于第一组（P<0.05）。
我们认为，无缝合引流法在治疗十二指肠溃疡穿孔方面与一期修复法同样有效，可以作为一期修复法的替代方法安全应用。然而，需要进一步的研究来充分确定无缝合引流法的疗效。
