Gülsen EKİNGEN, Canan CERAN, Arzu DEMİRTOLA, Billur DEMİROĞULLARI, Banu SANCAK, Aylar POYRAZ, Kaan SÖNMEZ, A.can BASAKLAR, Nuri KALE

İnce Barsak İskemi Reperfüzyonunda Reperfüzyon Süresinin Biyokimyasal Değişiklikler ve Anastomoz İyileşmesine Etkisi

Amaç: Bu çalışmada ince barsak dokusunda iskemi sonrası değişen reperfüzyon süresinin, biyokimyasal değişiklikler ve anastomoz iyileşmesine olan etkilerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Geçici barsak iskemisi oluşturulan 36 adet Wistar-Albino rat altı gruba ayrıldı: Kontrol grubu (sadece laparatomi), grup I (40 dk. iskemiyi takiben 20 dk. reperfüzyon), grup II (40 dk. iskemiyi takiben 24 sa. reperfüzyon), kontrol-A (ince barsak anastomozu), grup I-A (40 dk. iskemi, 20 dk. reperfüzyon ve ince barsak anastomozu), grup II-A (40 dk. İskemi, 24 sa. Reperfüzyon ve ince barsak anastomozu). Kontrol grubu, grup I ve II de reperfüzyon süresi bitince histopatolojik ve biyokimyasal değerlendirmeler için ince barsak doku örnekleri alındı. Kontrol grubu, grup I ve grup II de dokuda Myeloperoksidaz ve Süperoksit Dismutaz enzim düzeyleri ölçüldü. Kontrol-A grubu, grup I-A ve II-A da ise ince barsak anastomozu oluşturuldu. Anastomoz iyileşmesi, 4. gün patlama basıncı ve kollojen kontenti ölçülerek değerlendirildi. Bulgular: İnce barsak dokusunda myeloperoksidaz ve süperoksit dismutaz enzim düzeylerinin reperfüzyonun erken evrelerinde artarken 24. saatte azaldığı (p<0,05) saptandı. Geç dönemde yapılan anastomozlarda patlama basınçları ve hidroksiprolin kontentinin erken dönemdekine kıyasla daha düşük olduğu saptandı (p<0,05). Sonuç: İskemi/Reperfüzyon hasarı geç dönemde ince barsak anastomozlarının güvenilirliğini azaltmaktadır. İnce barsak anastomozları yapılırken bu durumun göz önünde bulundurulması gerekir. Anahtar kelimeler: İskemi/Reperfüzyon hasarı, Myeloperoksidaz, Süperoksit dismutaz, Anastomoz iyileşmesi.

Anahtar Kelimeler:

İskemi/Reperfüzyon hasarı, Myeloperoksidaz, Süperoksit dismutaz, Anastomoz iyileşmesi.

The Effect of Reperfusion Duration in Intestinal Ischemia-Reperfusion on Biochemical Parameters and Small Intestinal Anastomosis Healing

Aim: The aim of this study was to determine biochemical changes and evaluate anastomotic healing of small bowel in the early and late phase of reperfusion after intestinal ischemia. Material and method: Thirty-six Wistar albino rats were divided into 6 groups. Control group (Laparatomy only), group I (40 minutes intestinal ischemia followed by 20 minutes reperfusion), group II (40 minutes intestinal ischemia followed by 24 hours reperfusion), control-A group (Intestinal anastomosis creation), group I-A (40 minutes intestinal ischemia followed by 20 minutes reperfusion and intestinal anastomosis creation), and group II-A (40 minutes intestinal ischemia followed by 24 hours reperfusion and intestinal anastomosis creation). Small bowel samples were obtained in control group, group I and group II at the end of the reperfusion period for tissue myeloperoxidase and superoxide dismutase levels. After creation of small bowel anastomosis in the fourth day postoperatively, bursting pressure and hydroxyproline content were determined in control-A group, group I-A and group II-A. Results: Tissue myeloperoxidase and superoxide dismutase levels were increased significantly after 20 minutes reperfusion and than decreased to subnormal levels with in 24 hours of reperfusion (p<0,05). The bursting pressure and tissue hydroxyproline levels of the anastomosis created in the late reperfusion period (Group II-A) were found to be decreased in comparison with the Group I-A (p<0,05). Conclusion: Safety of small bowel anastomoses is reduced with prolonged reperfusion. This has to be kept in mind when constructing a small bowel anastomosis. Key words: Ischemia/Reperfusion injury, Myeloperoxidase, Superoxide dismutase, Anastomotic healing.

Keywords:

Ischemia/Reperfusion injury, Myeloperoxidase, Superoxide dismutase, Anastomotic healing.,

PDF

___

Park PO, Haglund U, Bulkley GB, Falt K. The sequence of development of intestinal tssue injury after strangulation ischemia and reperfusion. Surgery 1990;107:574-80.
Ladipo JK, Seidel SA, Bradshaw LA, Halter S, Wikswo JP Jr, Richards WO. Histopathologic changes during mesenteric ischaemia and reperfusion. West Afr J Med 2003;22:59-62.
Grisham MB, Hernandez CA, Granger N. Xanthine oxidase and neutrophil infiltration in intestinal ischemia. Am J Physiol 1986;251: 567–574
Tireli GA, Salman T, Ozbey H, Abbasoglu L, Toker G, Celik A. The effect of pentoxifylline on intestinal anastomotic healing after ischemia. Pediatr Surg Int 2003;19:88-90.
Kologlu M, Yorganci K, Renda N, Sayek I. Effect of local and remote ischemia- reperfusion injury on healing of colonic anastomoses. Surgery 2000;128:99-104.
Kuzu MA, Tanik A, Kale IT, Aslar AK, Koksoy C, Terzi C. Effect of ischemia/reperfusion as a systemic phenomenon on anastomotic healing in the left colon. World J Surg 2000;24:990-4.
Kuzu MA, Koksoy C, Kale IT, Tanik A, Terzi C, Elhan AH. Reperfusion injury delays healing of intestinal anastomosis in a rat. Am J Surg 1998;176:348-51.
Haglind E, Haglund U, Lundgren O, Stenberg B. Mucosal lesions of the small intestine after intestinal vascular obstruction in the rat. Acta Chir Scand 1985;151:147- 50.
Grisham MB, Everse J, Janssen HF. Endotoxemia and neutrophil activation in vivo.
Am J Physiol 1988;254:H1017-22.
Sun Y, Oberley LW, Li Y. A simple method for clinical assay of superoxide dismutase. Clin Chem, 1988;34:497-500.
Lowry OH, Rosebrough NJ, Farr AJ, Randall RJ. Protein measurement with folin phenol reagent. J Biol Chem, 1951;193:265-66.
Jamall IS, Finelli VN, Que Hee SS. A simple method to determine nanogram levels of 4-hydroxyproline in biological tissues. Anal Biochem 1981;112:70-5.
Shandall AA, Williams GT, Hallett MB,Young HL. Colonic healing: a role for polymorphonuclear leucocytes and oxygen radical production. Br J Surg 1986;73: 225–228.
Mc Govan SE, Murray JJ. Direct effect of neutrophil oxidants on elastase induced extracellular matrix proteolysis. Am Rev Respir Dis 1987;135: 1286–1293.
Hendriks THLB, Vereecken WLEM, Hesp PHM, Schillings PHM, De Boer HHM. Loss of collagen from experimental intestinal anastomoses: early events. Exp Mol Pathol 1985;42:411–418.
Mc Govan SE, Murray JJ. Direct effect of neutrophil oxidants on elastase induced extracellular matrix proteolysis. Am Rev Respir Dis 1987;135:1286–1293.
Grisham MB, Hernandez LA, Granger DN. Xanthine oxidase and neutrophil infiltration in intestinal ischemia. Am J Physiol 1986;251: G567-G574.
Demirogullari B, Sonmez K, Turkyilmaz Z, Ekingen G, Dursun A, Bor V, Turkozkan N, Basaklar AC, Kale N. Comparison of consequent small bowel anastomoses after transient ischemia: an experimental study in rats. J Pediatr Surg 1998;33:91-3.
Udassin R. Vromen A. Haskel Y. The time sequence of injury and recovery following transient reversible intestinal ischemia. J Surg Res 1994;56:221-225.
Hendriks T. Mastboom WJB. Healing of experimental intestinal anastomoses. Dis Colon Rectum 1990; 33:891-901.