Hendriks T, Wobbes T, de Man B M, Hoogenhout J, Seifert W F
Department of Surgery, University Hospital Nijmegen, The Netherlands.
Radiat Res. 1998 Oct;150(4):431-5.
Intraoperative irradiation appears to be a valuable addition to the modalities available to treat patients with large bowel cancer. However, its potential effect on healing of anastomoses has not been investigated extensively. For this purpose, male Wistar rats underwent colonic resection. Subsequently, 1 cm of each bowel end was irradiated with doses of 10, 15, 20 or 25 Gy and intestinal continuity was restored. After 3 or 7 days, animals were killed and the anastomoses were analyzed for bursting pressure (intraluminal force), breaking strength (longitudinal force) and hydroxyproline content. Intraoperative irradiation led to a massive (40-70%) and significant (P < 0.025) reduction in bursting pressure 3 days after operation compared to the control group for every dose used. After 7 days, the bursting site was outside the area of the anastomosis in all groups. The breaking strength at day 3 was also reduced, even after 10 Gy. At day 7, when tearing still occurred in the wound area, the breaking strength was still significantly lower in the 15- and 25-Gy groups than in the control group. The hydroxyproline content of the anastomoses was significantly reduced only after irradiation with the higher doses. Thus intraoperative irradiation constitutes a threat to early strength of anastomoses in the rat colon, and even at moderate doses it may threaten the integrity of the anastomosis.
术中放疗似乎是治疗大肠癌患者现有方法中的一项有价值的补充。然而，其对吻合口愈合的潜在影响尚未得到广泛研究。为此，对雄性Wistar大鼠进行结肠切除术。随后，对每段肠管的两端各1厘米处以10、15、20或25戈瑞的剂量进行照射，然后恢复肠道连续性。术后3天或7天处死动物，分析吻合口的破裂压力（腔内压力）、断裂强度（纵向力）和羟脯氨酸含量。与对照组相比，术中放疗导致术后3天使用的每个剂量组的破裂压力均大幅（40 - 70%）且显著（P < 0.025）降低。7天后，所有组的破裂部位均在吻合口区域之外。术后3天，即使是10戈瑞剂量，断裂强度也有所降低。在术后7天，当伤口区域仍发生撕裂时，15戈瑞和25戈瑞剂量组的断裂强度仍显著低于对照组。仅在高剂量照射后，吻合口的羟脯氨酸含量才显著降低。因此，术中放疗对大鼠结肠吻合口的早期强度构成威胁，即使是中等剂量也可能威胁吻合口的完整性。
