Kuzu M A, Köksoy C, Akyol F H, Uzal D, Kale T, Demirpence E
Department of Surgery, Ankara Numune, Turkey.
Dis Colon Rectum. 1998 Mar;41(3):370-6. doi: 10.1007/BF02237494.
Radiotherapy is frequently used as a (neo)adjuvant to surgery in colorectal cancer patients, and because such therapy could influence the integrity of the anastomosis, we decided to investigate the effect of preoperative irradiation on colonic anastomosis.
Seventy-two male Wistar rats, weighing 200 to 348 g, were divided into three groups: a control group (I) underwent left colon resection and primary anastomosis (n = 20); a sham irradiated group (II, n = 20); a study group (III) that received fractionated irradiation to the whole pelvis (anterior-posterior pelvic field), for a total dose of 22 Gy, 5.5 Gy per fraction, on four consecutive days with linear accelerator (n = 32). Four days after irradiation, both Groups II and III underwent the same operation as performed in Group I. Within each group, one-half of the animals were anesthetized on the third postoperative day and one-half on the seventh postoperative day. Abdominal wound-healing, anastomotic complications, and anastomotic bursting pressure measurements were recorded. Following these measurements, the anastomotic segment was resected for hydroxyproline content and myeloperoxidase activity.
Irradiated animals had more pronounced weight loss during therapy. There were no differences with abdominal wound-healing, intraperitoneal adhesions, and anastomotic complications between groups. At days 3 and 7, mean bursting pressures of the anastomosis were determined at 36.5 and 208 mmHg in Group I, 34.5 and 228 mmHg in Group II, and 25 and 150 mmHg in Group III, respectively (P < 0.01 Group III vs. both Groups I and II on days 3 and 7). The burst occurred at the anastomosis in all animals tested on the third postoperative day and one in Group I (10 percent), none in Group II, and six in Group III (37.5 percent) on the seventh postoperative day. In addition, hydroxyproline content and myeloperoxidase activity was significantly lower in Group III.
Although preoperative fractionated irradiation significantly decreased the anastomotic bursting pressure and more burst occurred in the anastomotic line on postoperative day 7, the clinical outcome was similar among the groups.
在结直肠癌患者中，放射治疗常被用作手术的（新）辅助治疗，鉴于这种治疗可能影响吻合口的完整性，我们决定研究术前放疗对结肠吻合口的影响。
将72只体重200至348克的雄性Wistar大鼠分为三组：对照组（I组）行左半结肠切除并一期吻合（n = 20）；假照射组（II组，n = 20）；研究组（III组）使用直线加速器对整个盆腔（前后盆腔野）进行分次照射，总剂量22 Gy，每次5.5 Gy，连续4天（n = 32）。照射后4天，II组和III组接受与I组相同的手术。在每组中，一半动物在术后第3天麻醉，另一半在术后第7天麻醉。记录腹部伤口愈合情况、吻合口并发症及吻合口破裂压力测量值。测量完成后，切除吻合段以检测羟脯氨酸含量和髓过氧化物酶活性。
接受照射的动物在治疗期间体重减轻更为明显。各组之间在腹部伤口愈合、腹腔粘连及吻合口并发症方面无差异。在第3天和第7天，I组吻合口的平均破裂压力分别为36.5和208 mmHg，II组为34.5和228 mmHg，III组为25和150 mmHg（术后第3天和第7天，III组与I组和II组相比，P < 0.01）。所有在术后第3天测试的动物吻合口均发生破裂，术后第7天，I组有1只（10%）、II组无、III组有6只（37.5%）发生破裂。此外，III组的羟脯氨酸含量和髓过氧化物酶活性显著降低。
虽然术前分次照射显著降低了吻合口破裂压力，且术后第7天吻合口处发生破裂的情况更多，但各组的临床结局相似。
