Hamzaoğlu I, Karahasanoğlu T, Aydin S, Sahin D A, Carkman S, Sariyar M, Alemdaroğlu K
Department of Surgery, Istanbul University Cerrahpasa and Istanbul Medical Schools, Turkey.
Am J Surg. 1998 Nov;176(5):458-61. doi: 10.1016/s0002-9610(98)00234-7.
Leakage from colonic anastomoses is a major complication causing increased mortality and morbidity, and ischemia is a well-known cause of this event. Inadequate tissue oxygenation could be reversed by using hyperbaric oxygen. This study was designed to investigate the effects of hyperbaric oxygen on the healing of ischemic and normal colon anastomoses in the rat model.
Standardized left colon resection 3 cm above the peritoneal reflection and colonic anastomosis were performed in 40 Wistar rats divided into four groups. The control group (I) received no further treatment. To mimic ischemia, 2 cm mesocolon was ligated on either site of the anastomosis in group II and IV rats. Hyperbaric oxygen therapy was started immediately after surgery in group III and IV rats (therapeutic groups). All animals were sacrificed on the fourth postoperative day. After careful relaparotomy, in situ bursting pressure was measured. The hydroxyproline contents of the anastomotic segments in equal length were determined.
The hydroxyproline assay revealed that rats in group II with ischemic colonic anastomosis have significantly lower levels (P <0.05). The highest levels are in the group III rats with normal colonic anastomosis treated by hyperbaric oxygen (P <0.05). There was no significant difference in hydroxyproline levels between group II and group IV animals (P >0.05). Group III animals had significantly higher bursting pressures than any other group (P <0.05). Group II rats had lowest bursting pressures (P <0.05). Group IV animals had significantly higher levels than group II (P <0.05). Mean bursting pressure values both in groups III and IV and hydroxyproline levels in group III were significantly increased by hyperbaric oxygen therapy (P <0.05).
Ischemia impairs anastomotic healing. Hyperbaric oxygen increases anastomotic healing of both normal and ischemic colonic anastomosis and reverses ischemic damage. This study demonstrated that hyperbaric oxygen improves anastomotic healing.
结肠吻合口漏是一种导致死亡率和发病率增加的主要并发症，而缺血是该事件的一个众所周知的原因。组织氧合不足可通过高压氧治疗得到改善。本研究旨在探讨高压氧对大鼠模型中缺血性和正常结肠吻合口愈合的影响。
将40只Wistar大鼠分为四组，进行标准化的在腹膜反折上方3 cm处的左半结肠切除及结肠吻合术。对照组（I组）不接受进一步治疗。为模拟缺血，在II组和IV组大鼠的吻合口两侧结扎2 cm的结肠系膜。III组和IV组大鼠（治疗组）在手术后立即开始高压氧治疗。所有动物在术后第4天处死。仔细再次剖腹后，测量原位破裂压力。测定等长吻合段的羟脯氨酸含量。
羟脯氨酸检测显示，II组缺血性结肠吻合口大鼠的水平显著较低（P <0.05）。最高水平见于接受高压氧治疗的III组正常结肠吻合口大鼠（P <0.05）。II组和IV组动物的羟脯氨酸水平无显著差异（P >0.05）。III组动物的破裂压力显著高于其他任何组（P <0.05）。II组大鼠的破裂压力最低（P <0.05）。IV组动物的水平显著高于II组（P <0.05）。高压氧治疗显著提高了III组和IV组的平均破裂压力值以及III组的羟脯氨酸水平（P <0.05）。
缺血会损害吻合口愈合。高压氧可促进正常和缺血性结肠吻合口的愈合，并逆转缺血损伤。本研究表明高压氧可改善吻合口愈合。
