Dominguez J M, Jakate S M, Speziale N J, Savin M H, Altringer W E, Saclarides T J
Department of General Surgery, Rush Medical College, Chicago, Illinois 60612, USA.
J Surg Res. 1996 Feb 15;61(1):293-9. doi: 10.1006/jsre.1996.0119.
The use of preoperative and intraoperative irradiation as surgical adjuncts in cancer management has led to concerns regarding post-operative wound healing. The optimum time to construct an intestinal anastomosis after irradiation has not been determined. The aim of this study was to evaluate anastomotic wound healing at varying times after irradiation. One hundred eighty-seven male Sprague-Dawley rats were randomized into seven experimental groups. Group I (control) had a sutured anastomosis and no irradiation. Groups II-VII received a single dose of 20 Gy intraoperatively. In group II, a sutured anastomosis incorporating irradiated bowel was performed immediately after irradiation. Groups III-VII underwent a second laparotomy to undergo a sutured anastomosis with irradiated bowel at 2 days, 1 week, 2 weeks, 3 weeks, and 4 weeks after irradiation. The rats were sacrificed 7 days after the anastomosis was created and the segment of terminal ileum containing the anastomosis was harvested. Tensile strength, hydroxyproline content, and modified Black irradiation damage scores were determined: [table: see text] The increasing modified Black scores reflect the progressive nature of irradiation damage over time. Increasing hydroxyproline content is seen after irradiation but this does not imply increasing wound strength. There was a return of tensile strength to normal levels by 2 weeks. These findings suggest that normal wound healing can be expected if a minimum of 2 weeks elapses between irradiation and intestinal anastomosis.
在癌症治疗中，将术前和术中放疗作为手术辅助手段引发了人们对术后伤口愈合的担忧。放疗后进行肠道吻合术的最佳时间尚未确定。本研究的目的是评估放疗后不同时间的吻合口伤口愈合情况。187只雄性斯普拉格-道利大鼠被随机分为7个实验组。第一组（对照组）进行缝合吻合术且未接受放疗。第二至七组在术中接受单次20 Gy的照射。在第二组中，放疗后立即进行包含受照射肠段的缝合吻合术。第三至七组在放疗后2天、1周、2周、3周和4周进行第二次剖腹手术，对受照射肠段进行缝合吻合术。在吻合口创建7天后处死大鼠，并采集包含吻合口的回肠末端段。测定拉伸强度、羟脯氨酸含量和改良布莱克辐射损伤评分：[表格：见原文]改良布莱克评分的增加反映了辐射损伤随时间的进展情况。放疗后可见羟脯氨酸含量增加，但这并不意味着伤口强度增加。拉伸强度在2周时恢复到正常水平。这些发现表明，如果放疗和肠道吻合术之间至少间隔2周，可以预期伤口能正常愈合。
