Seifert W F, Biert J, Wobbes T, Verhofstad A A, Hoogenhout J, Hendriks T
Department of Surgery, University Hospital Nijmegen, The Netherlands.
Int J Radiat Oncol Biol Phys. 1998 Oct 1;42(3):623-9. doi: 10.1016/s0360-3016(98)00259-4.
to determine whether intraoperative radiotherapy causes long-term negative effects on the healing of colonic anastomoses in the rat.
175 rats were divided into seven equal groups. One group served as sham-irradiated control group. In the others, following a colonic resection, 1 or 2 cm of the distal bowel limb was irradiated with a single dose of 10, 15, or 20 Gy (groups 10/1, 15/1, 20/1, 10/2, 15/2, and 20/2, respectively). Subsequently, an anastomosis was constructed. The animals were killed after 6 (n = 10 in each group) or 12 (n = 15) months. The abdomen was inspected for abnormalities and the colonic diameter was measured. The anastomotic segment was analyzed biochemically (hydroxyproline) and histologically.
During the experimental period, 1 rat (group 15/1) died because of anastomotic leakage and 3 others died from unknown causes. There was no difference in colonic diameter between groups. Altogether 17 rats developed an adenocarcinoma in the irradiated area: 11 of these had received a dose of 20 Gy. Histological observation indicated that fibrosis was present only in a limited number of animals, mostly after irradiation with a dose of 15 or 20 Gy. All anastomoses were functional and showed normal histology. The hydroxyproline content of the anastomotic segment was increased--with respect to the control group--only in the 20/2 group after 6 months. After 12 months, the hydroxyproline concentration in the (irradiated) segment distal to the anastomosis proper was higher in the 10/1 and 15/1 groups than in the control group. Otherwise, there were no differences between groups.
Intraoperative irradiation with a single dose of 10-20 Gy, delivered to the distal limb used for anastomotic construction, does not appear to constitute a threat to anastomotic integrity. Dose-related changes included formation of adenocarcinomas and fibrosis, but function and histology of the anastomosis proper remained unaffected.
确定术中放疗是否会对大鼠结肠吻合口愈合产生长期负面影响。
175只大鼠被分为七组，每组数量相等。一组作为假照射对照组。其他组在进行结肠切除术后，对远端肠段1或2厘米处以10、15或20 Gy的单次剂量进行照射（分别为10/1、15/1、20/1、10/2、15/2和20/2组）。随后进行吻合术。在6个月（每组n = 10）或12个月（n = 15）后处死动物。检查腹部有无异常并测量结肠直径。对吻合段进行生化（羟脯氨酸）和组织学分析。
在实验期间，1只大鼠（15/1组）因吻合口漏死亡，另外3只因不明原因死亡。各组之间结肠直径无差异。共有17只大鼠在照射区域发生腺癌：其中11只接受了20 Gy的剂量。组织学观察表明，仅在少数动物中出现纤维化，主要是在接受15或20 Gy剂量照射后。所有吻合口均功能正常且组织学表现正常。仅在6个月后的20/2组中，吻合段的羟脯氨酸含量相对于对照组有所增加。12个月后，10/1和15/1组吻合口远端（照射）段的羟脯氨酸浓度高于对照组。除此之外，各组之间无差异。
对用于吻合构建的远端肠段进行10 - 20 Gy的单次术中照射，似乎不会对吻合口完整性构成威胁。与剂量相关的变化包括腺癌形成和纤维化，但吻合口本身的功能和组织学未受影响。
