Duraker N, Bender O, Memişoğlu K, Yalçiner A
Third Department of Surgery, SSK Okmeydani Training Hospital, Istanbul, Turkey.
Int J Colorectal Dis. 1998;13(5-6):232-4. doi: 10.1007/s003840050167.
This study investigated the effects of intraoperative colonic irrigation and proximal diverting end colostomy after segmental bowel resection in experimental left-colonic obstruction on anastomotic healing. Simple obstruction of descending colon was performed in male Sprague-Dawley rats. After 24 h we performed segmental colonic resection and anastomosis in the control group (n = 15); resection, anastomosis, and covering colostomy in the colostomy group (n = 14); resection and anastomosis after antegrade colonic lavage through cecum by using isotonic saline solution in the irrigation group (n = 13). In rats that were killed 7 days later anastomotic dehiscence and bursting pressure and tissue hydroxyproline concentration at the anastomosis were measured. No significant differences were observed between groups in terms of anastomotic dehiscence, bursting site, or pressure. The hydroxyproline concentration was significantly higher in the irrigation group than the control group (P = 0.025) and the colostomy group (P = 0.029), but no difference was noted between the control group and the colostomy group. These findings suggest that intraoperative antegrade colonic irrigation in the acute left-sided colonic obstruction positively affects collagen metabolism at the anastomotic site; if the anastomosis is performed without bowel cleansing, covering colostomy does not improve collagen metabolism.
本研究调查了实验性左半结肠梗阻行节段性肠切除术后术中结肠灌洗和近端转流性结肠造口术对吻合口愈合的影响。对雄性Sprague-Dawley大鼠进行降结肠单纯梗阻。24小时后，对照组（n = 15）行节段性结肠切除并吻合；结肠造口组（n = 14）行切除、吻合及覆盖式结肠造口术；灌洗组（n = 13）经盲肠用等渗盐溶液进行顺行结肠灌洗后行切除和吻合。在术后7天处死的大鼠中，测量吻合口裂开情况、破裂压力及吻合口处组织羟脯氨酸浓度。各组间在吻合口裂开、破裂部位或压力方面未观察到显著差异。灌洗组的羟脯氨酸浓度显著高于对照组（P = 0.025）和结肠造口组（P = 0.029），但对照组和结肠造口组之间未发现差异。这些结果表明，急性左侧结肠梗阻术中顺行结肠灌洗对吻合口部位的胶原代谢有积极影响；如果在未进行肠道清洁的情况下进行吻合，覆盖式结肠造口术并不能改善胶原代谢。
