再灌注损伤会延迟大鼠肠吻合口的愈合。

Reperfusion injury delays healing of intestinal anastomosis in a rat.

作者信息

Kuzu M A, Köksoy C, Kale I T, Tanik A, Terzi C, Elhan A H

机构信息

Department of Surgery, Faculty of Medicine, University of Ankara, Turkey.

出版信息

Am J Surg. 1998 Oct;176(4):348-51. doi: 10.1016/s0002-9610(98)00198-6.

DOI:10.1016/s0002-9610(98)00198-6

PMID:9817253

Abstract

BACKGROUND

Revascularization of ischemic bowel may induce further local tissue damage due to reperfusion injury. Therefore, we aimed to investigate the effect of ischemia-reperfusion injury on the healing of intestinal anastomosis in experimental models.

METHODS

One hundred and two male Wistar rats were divided into three groups: a control group (group I, n = 23); an ischemia group (group II, n = 32), in which only the superior mesenteric artery (SMA) was occluded for 30 minutes; and a profound ischemia group (group III, n = 47), in which SMA was occluded as well as collateral vessels for 30 minutes. The pulsations were seen to return to marginal vessels and the bowels began to appear pinker and healthier in all groups following the restoration of arterial flow. Then, all animals underwent a 3-cm ileal resection and primary anastomosis, 10 cm proximal to the ileocecal valve. Within each group, animals were anesthetized either on the third or seventh postoperative days. Abdominal wound healing, intraabdominal adhesions, anastomotic complications, anastomotic bursting pressure measurements, and bursting site were recorded.

RESULTS

Statistically significant differences were detected in intraperitoneal adhesion scores in group II and III (P <0.001). Anastomotic dehiscence was found in 2 of 23 (9%) in group I, 5 of 32 (16%) in group II, and 16 of 47 (34%) in group III (P <0.001). On the third and seventh days, the median bursting pressures of the anastomosis were determined to be 42 mm Hg and 250 mm Hg in group I, 46 and 253 in group II, and finally 19 and 90 mm Hg in group III (P <0.01). The burst occurred at the anastomoses in all animals tested on the third postoperative day, none in group I, 4 (28%) in group II, and 8 (67%) in group III on the seventh postoperative day (P <0.005).

CONCLUSION

The present study demonstrated that ischemia-reperfusion impairs anastomotic healing. Despite the fact that the intestines are well perfused and viable after revascularization, one must bear in mind that intestinal reperfusion may compromise anastomotic healing.

摘要

背景

缺血性肠管的血管再通可能因再灌注损伤而导致进一步的局部组织损伤。因此，我们旨在研究实验模型中缺血再灌注损伤对肠吻合口愈合的影响。

方法

102只雄性Wistar大鼠分为三组：对照组（I组，n = 23）；缺血组（II组，n = 32），仅阻断肠系膜上动脉（SMA）30分钟；深度缺血组（III组，n = 47），阻断SMA及其侧支血管30分钟。恢复动脉血流后，所有组边缘血管的搏动均恢复，肠管开始变得更红润、更健康。然后，所有动物均行距回盲瓣近端10 cm处3 cm的回肠切除及一期吻合术。每组动物在术后第3天或第7天进行麻醉。记录腹部伤口愈合情况、腹腔粘连情况、吻合口并发症、吻合口破裂压力测量结果及破裂部位。

结果

II组和III组的腹腔粘连评分有统计学显著差异（P <0.001）。I组23只中有2只（9%）发生吻合口裂开，II组32只中有5只（16%），III组47只中有16只（34%）（P <0.001）。在术后第3天和第7天，I组吻合口的中位破裂压力分别为42 mmHg和250 mmHg，II组为46和253，III组最终为19和90 mmHg（P <0.01）。术后第3天测试的所有动物吻合口均发生破裂，术后第7天I组无破裂，II组4只（28%），III组8只（67%）（P <0.005）。