Metin ŞEN, Ersin TUNCER, Sedat ÇİFTEL, Erkan HAZAR

Ameliyat sonrası gelişen karın içi yapışıklıkların önlenmesinde metilen mavisinin etkinliğinin histopatolojik olarak değerlendirilmesi: Deneysel bir çalışma

Amaç. İntestinal tıkanıklıkların önemli bir nedeni ameliyat sonrası yapışıklıklardır. Bu çalışmanınamacı, metilen mavisinin ameliyat sonrası yapışıklıkları önleyici etkilerini araştırmaktır. Yöntem.Matür 40 adet sıçan kullanılıp, ameliyat öncesi sıçanlar rastgele olarak her biri 10 sıçandan oluşan4 gruba ayrıldı. I. Gruba çekum ön duvarında 0,5 cmlik alan 15 no lu bistüri ile travmatizeedilerek, II. Gruba çekum ön duvarda 1 cmlik alana bistüri ile tam kat kesildi ve kapatıldı. Bu ikigruba karın içerisine 2 mL SF konuldu. III. Gruba çekum ön duvarında 0,5 cmlik alan 15 nolubistüri ile travmatize edilerek, IV. Gruba çekum ön duvarda 1 cmlik alana bistüri ile tam katkesildi ve kapatıldı. Bu iki gruba da karın içerisine %1lik metilen mavisinden 2 mL konuldu.Ameliyat sonrası 14. günde çekumdan histopatolojik inceleme için biyopsi alınarak fıbrozis,neovaskülarizasyon, ve inflamasyon dereceleri incelendi. Bulgular. Fibrozis bakımından; 2 ve 4.Gruplar tamamen pozitif (+), 1. Grubun %80i negatif (-) olarak değerlendirildi. İnflamatuar cevapiçin hastaların %25i negatif (-), %75i pozitif (+)tir. 2. Grup için tamamı %100ü pozitif (+)tir.Neovaskülarizasyon bakımından, tüm hastaların %35i negatif (-) %65i pozitif (+)tir. Hergruptan en az bir hasta negatifken en çok 1. Grupta %70 negatif (-) hasta vardır. Mezotel hücreproliferasyonu bakımından, hastaların %27.5i negatif,%62.5i pozitif(+)tir. Grup 1denegatiflik(-) oranı %80, grup3te pozitiflik oranı %90, grup 4 için deneklerin tamamı pozitiftir.Sonuç. Metilen mavisinin fıbrozisi, neovaskülarizasyonu ve inflamasyonu azaltmadığı, mezotelhücre proliferasyonunu azalttığı görüldü. Bu bulgular, metilen mavisinin mezotel hücreproliferasyonunu azaltarak ameliyat sonrası yapışıklıkları önleyebileceğini desteklemektedir"

The efficiency of methylene blue against postoperative adhesions: An experimental study

Aim. Post-operative adhesions are a major cause of intestinal obstructions. The aim of this study isto investigate the effects of methylene blue on preventing post-operative adhesions. Methods.Forty mature rats were used. They were randomly divided into four groups of 10 rats. In group I,0.5 cm area at the front side of the caeceum was traumatized using a No: 15 lancet, in group II thefront side of the caeceum was cut through for 1 cm by lancet and closed. In both groups 2 ml ofsaline was added into the abdomen. In group III 0.5cm area at the front side of the caeceum wastraumatized using a No: 15 lancet, in group IV the front side of the caeceum was cut through for 1cm by lancet and closed. In both groups 2 mL of 1% methylene blue was added into the abdomen.On the postoperative 14th day biopsy was taken for histopathological examination; at whichdegrees of fibrosis, neovascularization and inflammation were evaluated. Results. By means offibrosis; the second and fourth groups found to be completely positive while eighty percent of thefirst group was negative. By means of inflammatory response, twenty-five of the patients werenegative while seventy-five percent of them were positive. All of the patients in the second groupwere positive. By means of neovascularization; thirty-five percent of all patients were negativewhile sixty-five of them were positive. While at least one patient from each group was negative;seventy percent of the patients in the first group being the largest number of patients whencompared with the other groups were negative. By means of mesothelial cell proliferation; 27.5percent of the patients was negative while 62.5 percent of the patients was positive. The negativityratio of group 1 was 80%, while it was 90% for group 3 and it was positive for all of the patients ingroup 4. Conclusion. We found that methylene blue does not decrease fibrosis, neovascularizationand inflammation but it was found to decrease mesothelial cell proliferation. These findingssuggest that methylene blue can decrease post-operative adhesions by decreasing mesothelial cellproliferation.

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