Ratlarda deneysel oluşturulan iskemik kolon anastomozlarının amniyotik membran ile sarılmasının anastomoz güvenliğine etkisi

Amaç: Kolon anastomoz kaçağı yüksek mortalite ve morbidite ile seyreden bir komplikasyondur. Bu çalışmada iskemik kolon anostomoz iyileşmesine amniyon zarının etkisini araştırmayı amaçladık. Yöntem: 25 adet vistar albino cinsi 19-21 günlük gebe rat rastgele 5 gruba ayrıldı. Orta hattan yapılan laparatomi ile gebelikler sonlandırıldı ve taze amniyon zarı elde edildi. Grup 1Sham(S); laparatomi dışında işlem yapılmadı. Grup 2 kolon anastomozu(A) ; inen kolon tam transekte edilerek anastomoz uygulandı. Grup3 amniyonlu anastomoz (AA); anastomoz hattına taze amniyon zarı sarılarak tesbit edildi. Grup 4 kolon iskemik anastomoz(İA); inen kolon transeksiyonu sonrası marjinal arterler bağlandı. İskemi oluşturuldu. Anastomoz yapıldı. Grup 5 amniyon zarı sarılmış kolon iskemik anastomoz(AİA); iskemik kolon anastomozu yapıldıktan sonra anastomoz hattına amniyon zarı sarılarak tesbit edildi. Postoperatif 7 günde ratlar sakrifiye edilerek anastomoz patlama basınçları ölçüldü. Histolojik inceleme için anastomoz hattını içeren kolon segmenti çıkarıldı. Hemotoksilen eozin ve Van gieson trichtome boyalı örnekler histolojik olarak değerlendirilerek Ehrlich-Hunt modeline göre skorlandı. Bulgular: Anastomoz patlama basıncı değerleri en yüksek S grubunda, azalan sıra ile AA, AİA, A ve en düşük İA grubunda ölçüldü. Patlama basıncı değerlerine göre grupların ikili karşılaştırmasında S ile AA grupları arası fark istatiksel olarak anlamsız olarak hesaplandı (p=0,222). Diğer ikili karşılatırıldığında gruplar arası fark anlamlı olarak hesaplandı (p< 0.05). Grupların Ehrlich-Hunt modeline göre toplam skor en yüksek AİA ve azalan sıra ile AA, İA, A ve en düşük S grubunda olduğu bulundu. Gruplar arası toplam skorlar için ikili karşılaştırmada S ile A gruplar arası istatiksel olarak anlamsız olarak hesaplandı(p=0,222). Diğer ikili karşılaştırmalar istatiksel olarak anlamlı olarak hesaplandı (p< 0.05). Sonuç: Kolon anastomoz hattına amniyon zarı sarılması hem iskemik kolonda hemde iskemik olmayan kolonda patlama basıncı ve histopatolojik olarak anastomoz güvenliği açısından olumlu sonuçlar vermiştir.

Effect of the wrapping of experimentally induced ischemic colonic anastomoses with the amniotic membrane on anastomosis safety in rats.

Objective: Colonic anastomotic leakage represents a complication with high mortality and morbidity. In the presentstudy, it was aimed to examine the effect of the amniotic membrane on the healing of ischemic colonic anastomosis.Method: 25 pregnant Wistar albino rats aged 19-21 days were randomly divided into 5 groups. With midlinelaparotomy, pregnancies were terminated, and fresh amniotic membranes were obtained. In Group 1 Sham (S), noprocedure except for laparotomy was performed. In Group 2 of colonic anastomosis (A), the descending colon wascompletely transected and anastomosed. In Group 3 of amniotic anastomosis (AA), the anastomosis line was fixed bybeing wrapped with the fresh amniotic membrane. In Group 4 of colonic ischemic anastomosis (IA), the marginalarteries were ligated after descending colon transection. Ischemia was induced, and anastomosis was performed. InGroup 5 of colonic ischemic anastomosis wrapped with the amniotic membrane (AIA), after ischemic colonicanastomosis was performed, the anastomosis line was fixed by being wrapped with the amniotic membrane. On thepostoperative 7th day, rats were sacrificed, and their anastomotic bursting pressures were measured. For histologicalexamination, the colon segment containing the anastomosis line was removed. Hematoxylin-eosin and Van Giesontrichrome stained specimens were histologically evaluated and scored according to the Ehrlich-Hunt model.Results: Anastomotic bursting pressures were measured in group S as the highest, in AA, AIA, A in a decreasing orderand in group IA as the lowest. The difference between groups S and AA was statistically insignificant in the pairedcomparison of groups according to their bursting pressure values (p=0.222). When the other pairs were compared, thedifference between the groups was calculated as significant (p< 0.05). According to the Ehrlich-Hunt model, the totalscore was the highest in AIA group, decreased in AA, IA, A groups in a decreasing order, and was the lowest in groupS. A paired comparison for total scores between the groups was statistically insignificant between groups S and A(p=0.222). Other paired comparisons were statistically significant (p< 0.05).Conclusions: Wrapping the colon anastomosis line with the amniotic membrane gave positive results both in theischemic colon as well as in the non-ischemic colon in terms of bursting pressure and histological anastomosis safety.

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