Hakan ERPEK, Çiğdem YENİSEY, Aykut SOYDER, Eyüp Murat YILMAZ, Evrim KALLEM, İbrahim METEOĞLU

Deneysel Kolon Anastomozunda Glutamin, Arjinin ve Beta Hidroksibütiratın Anastomoz Kaçağına Etkisi

Amaç: Kolon anastomozu ile ilgili kaçak nedenleri konusunda devam etmekte olan araştırmalar vardır. Bu çalışmada anastomoz dayanıklılığının ameliyat öncesinde beta-hidroksi-metil bütirat (HMB) ile artıp artmayacağı denetlenmiştir. Gereç ve Yöntemler: Kırk rat 4 gruba randomize edildi. Grup A (n=10) ratları standart rat yemi ile birlikte arjinin+glutamin+HMB’den zengin diyetle 7 gün beslendikten sonra sağ kolon transeksiyonu ve uç uca anastomoz uygulandı. Grup B (n=10) denekleri rat yemi ile birlikte arjinin ve glutaminden zengin diyet 7 gün beslendikten sonra aynı cerrahi işlem uygulandı. Grup C (n=10) 7 günlük rat yemi ile birlikte glutaminden zengin gıda ile beslendikten sonra cerrahiye alındı. Grup D (n=10) ratları sadece standart yem ile 7 gün beslendikten sonra ameliyata alındı. Tüm denekler postoperatif 7 gün boyunca beslendiler. Yedinci gün tüm ratlar anestezi altında sakrifiye edilerek anastomoz patlama basınçları ölçüldü. Hidroksiprolin değerleri ve histolopatolojik skorlama için anastomoz hattından örnek alındı. Bulgular: Çalışmamızda A ve B grubunda hidroksiprolin düzeylerinde 7 günde belirgin ölçüde artmış hidroksiprolin düzeyleri saptandı. Gruplar arasında anastomoz patlama basıncı ve histolojik iyileşme parametreleri anlamında fark yoktu. Sonuç: Enteral HMB desteği anlamlı artmış biyokimyasal anastomoz direnci sağlayabilir, ancak biyokimyasal güçte fark olmayabilir. HMB’nin yararını ortaya koymak için daha fazla çalışma gereksinimi olmasına rağmen preoperatif enteral HMB desteği postoperatif postoperatif mortalite ve morbiditeyi düşürebilir.

Effects of Glutamine, Arginine and Beta Hydroxymethybutyrate on Anastomotic Leakage in Experimental Colon Anastomosis

Objective: The studies on anastomotic leakage which is one of the leading serious complications of colonic anastomoses keep going as well as other surgical researches. This study was designed to investigate effects of hydroxy-ß-methyl butyrate (HMB) on anastomotic healing. Materials and Methods: Forty rats were randomized into four groups. Group A (n=10) rats received chow food plus arginine+glutamine+HMB rich diet for 7 days before right colonic transection followed by an end-to-end anastomosis. Group B (n=10) rats received chow food plus arginine and glutamine rich diet for 7 days before the same surgical procedure. Group C (n=10) rats underwent the same procedure after a 7-day chow plus glutamin rich diet. Group D (n=10) rats had the surgery after a chow food only diet for seven days. All the subjects were fed accordingly to their groups for 7 days postoperatively. On the 7th day, all rats were sacrificed under anesthesia to measure anastomotic bursting pressure and evaluate hydroxyproline levels as well as histopathological scoring of anastomotic line. Results: This study revealed significantly increased hydoxyproline level at the 7th day in group A (p

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