Wheeless C R, Zanagnolo V, Bowers D, Brenner M J, Lilley R
Department of Obstetrics and Gynecology, Sinai Hospital of Baltimore, Maryland 21215, USA.
Gynecol Oncol. 1998 Jul;70(1):121-2. doi: 10.1006/gyno.1998.5045.
The potential for postoperative complications in irradiated intestinal anastomoses is well known. There has been limited evaluation of factors that may improve wound healing in radiation-injured bowel. Growth hormone (GH) has been shown to improve wound healing. In animal models GH has been demonstrated to increase strength of large bowel anastomoses in nonirradiated bowel. The purpose of this study was to evaluate, in a rat model, the effect of GH on the bursting pressure of radiation-injured terminal ileal anastomoses in a rat model. Fifty-four rats were treated with 1700 cGy of pelvic irradiation in a single dose. Seventeen weeks later resection of a segment of terminal ileum and an ileo-ileostomy was performed. Half the rats received GH (2.0 mg/kg/day) and the rest received normal saline subcutaneously for 7 days starting on the day of surgery. On the seventh postoperative day the anastomosis site was identified at reoperation and bursting pressure was measured in vivo. A significantly greater bursting pressure was observed in the GH-treated rats compared to the control group (208.9 +/- 27 cm H2O vs 177 +/- 53 cm H2O, P < 0.025). GH treatment resulted in an 18% greater strength of radiation-injured terminal ileal anastomotic segments, as measured by bursting pressure. These findings suggest a possible role for GH in decreasing the morbidity in patients who undergo intestinal surgery after radiation treatment.
放射性肠吻合术后发生并发症的可能性是众所周知的。对于可能改善放射性损伤肠道伤口愈合的因素，评估一直有限。生长激素（GH）已被证明可促进伤口愈合。在动物模型中，GH已被证实能增强非放射性肠道中大肠吻合口的强度。本研究的目的是在大鼠模型中评估GH对放射性损伤的回肠末端吻合口破裂压力的影响。54只大鼠接受单次1700 cGy的盆腔照射。17周后，切除一段回肠末端并进行回肠-回肠造口术。一半大鼠从手术当天开始皮下注射GH（2.0 mg/kg/天），其余大鼠皮下注射生理盐水，持续7天。术后第7天，再次手术时确定吻合口部位，并在体内测量破裂压力。与对照组相比，接受GH治疗的大鼠的破裂压力明显更高（208.9±27 cm H2O对177±53 cm H2O，P<0.025）。通过破裂压力测量，GH治疗使放射性损伤的回肠末端吻合段强度提高了18%。这些发现表明，GH在降低放疗后接受肠道手术患者的发病率方面可能发挥作用。
