Tepper J E, Sindelar W, Travis E L, Terrill R, Padikal T
Int J Radiat Oncol Biol Phys. 1983 Jul;9(7):987-92. doi: 10.1016/0360-3016(83)90385-1.
Radiation has been given intraoperatively to various abdominal structures in dogs, using a fixed horizontal 11 MeV electron beam at the Armed Forces Radiobiologic Research Institute. Animals were irradiated with single doses of 2000, 3000 and 4500 rad to a field which extended from the bifurcation of the aorta to the rib cage. All animals were irradiated during laparotomy under general anesthesia. Because the clinical use of intraoperative radiotherapy in cancer treatment will occasionally require irradiation of anastomosed large vessels and blind loops of bowel, the tolerance of aortic anastomoses and the suture lines of blind loops of jejunum to irradiation were studied. Responses in these experiments were scored at times up to one year after irradiation. In separate experiments both aortic and intestinal anastomoses were performed on each animal for evaluation of short term response. Response was graded by arteriography, gastrointestinal roentgenography, blind loop bursting pressure, and pathologic findings at autopsy and microscopic evaluation. The dogs with aortic anastomoses showed adequate healing at all doses with no evidence of suture line weakening. On long-term follow-up one animal (2000 rad) had stenosis at the anastomosis and one animal (4500 rad) developed an arteriovenous fistula. Three of the animals that had an intestinal blind loop irradiated subsequently developed intussusception, with the irradiated loop acting as the lead point. One week after irradiation, bursting pressure of an intestinal blind loop was normal at 3000 rad, but markedly decreased at 4500 rad. No late complications were noted after the irradiation of the intestinal anastomosis. Thus, it appears that adequate healing can take place with minimal risk of suture line breakdown even after a high single dose of irradiation (up to 3000 rad) to an anastomotic site. No late complications were observed after irradiation of intestinal anastomoses, but one needs to be cautious with regards to possible late stenosis at the site of an irradiated vascular anastomosis.
在美国武装部队放射生物学研究所，使用固定水平的11兆电子伏电子束，在术中对狗的各种腹部结构进行了放射治疗。动物接受了单次剂量为2000、3000和4500拉德的照射，照射野从主动脉分叉延伸至胸廓。所有动物均在全身麻醉下剖腹手术期间接受照射。由于术中放射治疗在癌症治疗中的临床应用偶尔需要照射吻合的大血管和肠盲袢，因此研究了主动脉吻合口和空肠盲袢缝线对辐射的耐受性。在这些实验中，在照射后长达一年的时间内对反应进行评分。在单独的实验中，对每只动物进行主动脉和肠吻合术，以评估短期反应。通过动脉造影、胃肠X线造影、盲袢破裂压力以及尸检和显微镜评估的病理结果对反应进行分级。有主动脉吻合术的狗在所有剂量下均显示愈合良好，没有缝线减弱的迹象。长期随访中，一只动物（2000拉德）吻合口出现狭窄，一只动物（4500拉德）出现动静脉瘘。三只接受肠盲袢照射的动物随后发生肠套叠，照射的肠袢作为套入点。照射一周后，肠盲袢在3000拉德时破裂压力正常，但在4500拉德时明显降低。肠吻合口照射后未观察到晚期并发症。因此，即使对吻合部位进行高单次剂量照射（高达3000拉德），似乎也能实现充分愈合，缝线破裂风险最小。肠吻合口照射后未观察到晚期并发症，但对于照射的血管吻合部位可能出现的晚期狭窄需要谨慎对待。
