Hülya AKGÜN, Tuncay ÖZGÜN, Ahter Tanay TAYYAR

Sıçan uterin horn modelinde enoksaparin ve rapamisinin adezyon oluşumuna etkilerinin karşılaştırılması

Amaç. Birçok çalışmada düşük molekül ağırlıklı heparinlerin (DMAH) postoperatif adezyongelişimini önlemede etkili olduğu, bazı çalışmalarda da rapamisinin immünosüpresif bir ajanolarak postoperatif adezyon gelişimini azaltabileceği saptanmıştır. Bu deneysel çalışmada birDMAH olan enoksaparin ile rapamisinin tek tek veya birlikte adezyon oluşumu üzerine etkilerisıçan uterin horn modelinde incelendi. Yöntem. Çalışmada ağırlıkları 200-250 gr arasında olan 40adet Wistar-Albino dişi sıçan kullanıldı. Sıçanların karın duvarına anestezi altında steril koşullarda3 cmlik orta hat kesisi yapıldı. Her iki uterin hornda antimezenterik yüzeye 8-10 adet unipolarkoterizasyon uygulandı ve antimezenterik yüzeyler 4/0 polidioksanon ile karın ön duvarperitonuna dikildi. Sıçanlar kontrol, enoksaparin, rapamisin ve enoksaparin ve rapamisingruplarına (n= 10) ayrıldı. Kontrol grubunda adezyon önleyici tedavi uygulanmadan karın katlarıusulüne uygun olarak kapatıldı. Enoksaparin grubunda 14 gün süreyle enoksaparin 50 U/kgintraperitoneal olarak uygulandı. Rapamisin grubunda 14 gün süreyle 0,8 mg/kg oral yoldan gavajtüpüyle rapamisin uygulandı. Enoksaparin ve rapamisin grubunda 14 gün süreyle enoksaparin 50U/kg intraperitoneal olarak verildi, ayrıca aynı süreyle 0,8 mg/kg oral yoldan gavaj tüpüylerapamisin ilave olarak uygulandı. Sıçanların tümü 14 gün sonra letal doz pentobarbital ileöldürülerek orta hat kesisi ile laparotomi yapılarak adezyon gelişimi gözle ve histopatolojik olarakdeğerlendirildi. Bulgular. Makroskopik ve mikroskopik olarak incelendiğinde çalışma gruplarınınadezyon şiddetleri benzer bulundu (p>0,05). İlaç uygulanan grupların adezyon yaygınlığı ve totaladezyon skorları kontrol grubununkine göre daha düşük bulundu (p0,05).Sonuç. Enoksaparin ve rapamisin benzer düzeylerde total adezyonu önlemekte, bunu yaparkenadezyon şiddetinden daha çok adezyon yaygınlığını azaltarak etkili olmaktadır. Birliktekullanımlarında ise adezyon oluşumu üzerine etkileri sinerjistik değildir.

Comparison of effects of enoxaparin and rapamycin on adhesion f ormation in a rat uterine horn model

Aim. Several studies have demonstrated that low molecular weight heparins (LMWHs) decreasedpostoperative adhesion formation. Also, a few studies have noted that immunosuppressive agentrapamycin decreased postoperative adhesion formation. In this experimental study, we aimed toinvestigate the effect of enoxaparin and rapamycin alone and in combination on the adhesionformation in a rat uterine horn model. Methods. Our study included 40 Wistar-Albino ratsweighing between 200-250 g. Control and three study groups were formed including 10 rats. Insterile condition, we performed 3-cm midline incision of abdominal wall under general anesthesia.On the antimesenteric surface of both uterine horns, 8-10 unipolar electrocauterization wereapplied. Later these antimesenteric surfaces were sutured to abdominal sidewalls with 4.0polydioxanone. In the control group, no therapy was applied after surgery and incision was closedaccording to general surgical rules. In the enoxaparin group, enoxaparin 50 U/kg was appliedintraperitoneally for 14 days. In the rapamycin group, rapamycin 0.8 mg/kg was applied orallywith feeding tube for 14 days. In the enoxaparin plus rapamycin group, enoxaparin 50 U/kg wasapplied intraperitoneally and rapamycin 0.8 mg/kg orally with the feeding tube for 14 days. Theanimals were sacrificed by lethal dose pentobarbital 14 days after surgery and a midlinelaparatomy was carried out and abdominal cavity was inspected for the presence of adhesion andadhesion samples were obtained for histopathological examination. Results. According to thefindings of macroscopic and microscopic evaluation, the scores of adhesion severity were foundcomparable among the enoxaparin, rapamycin and enoxaparin plus rapamycin groups (p>0.05);however, the scores of adhesion extent and total adhesion scores were significantly lower in thedrug groups compared to the control group (p0.05). Conclusion. Enoxaparineand rapamycin prevent total adhesion similarly, however, this effect is considerable on the extentof adhesion rather than the severity of adhesion. Combination of enoxaparin and rapamycin did notshow synergistic effect on adhesion formation.

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