mmj

Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi

2148-8118 2618-6020

Muğla Sıtkı Koçman Üniversitesi

Surgery

Cerrahi

İntraperitonal PEG-4000 Uygulanmasının İnce Barsak Anastomozuna Etkileri: Deneysel Çalışma

Effects of Intraperitoneal PEG-4000 Administration on Small Bowel Anastomosis: Experimental Study

https://orcid.org/0000-0001-8252-3339

Özcan

Önder

Muğla Sıtkı Koçman Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı, Muğla

12 04 2018

5 3 16 23 08 13 2018 09 27 2018

2014

Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi

Abdominal cerrahi girişim sonrası ortaya çıkanperitoneal adezyonlar halen önemini korumaktadır. Postoperatif peritonealadezyonu önlemeye yönelik yapılan PEG-4000 ile ilgili çalışmalardan anlamlısonuçlar alınmıştır. Ancak PEG-4000’in gastrointestinal anastomozlarda yaraiyileşmesi üzerindeki etkilerine yönelik yeterince deneysel veya klinik çalışmayapılmamıştır. Bu çalışma 64 adet tavşan (16 denekten oluşan 4 grup) üzerindekontrollü deneysel çalışma olarak planlandı. Grup 1, 2 ve 3'deki deneklerelaparotomi yapılarak ileokolik bileşkenin 10 cm proksimalinden transeksiyon veileo-ileal uç uca anastomoz yaptık. Grup 1'e 20 ml intraperitonal olarak%40'lık PEG-4000, Grup 2'ye 20 ml %20'lik PEG-4000 ve Grup 3'e 20 ml serumfizyolojik uyguladık. Grup 4'e ise sadece laparotomi yaptık. Her bir grubukendi içinde sekizer denekten oluşan iki alt gruba (a ve b) ayırdık, a grubunapostoperatif ikinci gün, b grubuna ise postoperatif yedinci gün relaparotomiyaptık. Aanastomozun 5 cm proksimalini ve 4 cm distalini içine alacak şekildeileum rezeksiyonu yaptık. Kontrol grubuna ileokolik bileşkenin 10 cmproksimalinden 10 cm'lik ileum rezeksiyonu yaptık. Çıkarılan dokulardaanastomozdaki doku hidroksiprolin düzeylerini ölçtük, histopatolojik incelemeyaptık ve postoperatif yedinci gün anastomoz ayrılma basınçlarını ölçtük.Kontrol grubu ile çalışma grupları karşılaştırıldığında, hidroksiprolin miktarlarının,histopatolojik inceleme sonuçlarının ve anastomoz ayrılma basınçlarının kontrolgrubunda anlamlı olarak yüksek olduğunu tespit ettik. İntraperitoneal olarak%40'lık PEG-4000 uygulanmasının serum fizyolojik uygulanmasına göre yaraiyileşmesi üzerinde hem postoperatif ikinci günde hem de postoperatif yedincigünde olumsuz etki yaptığını tespit ettik. %40'lık PEG-4000 kullanımının%20'lik PEG-4000 kullanımına göre yara iyileşmesi üzerinde postoperatif ikincigünde olumsuz etkisinin olmadığını, postoperatif yedinci günde yara iyileşmesiüzerinde anlamlı olarak olumsuz etkisinin olduğunu gördük.

Peritoneal adhesion, which is seen afterabdominal operations, is still an important problem. Studies showed thatPEG-4000 could prevent abdominal adhesions, but the effects of PEG-4000 onanastomotic healing are unclear. To research these effects an experimentalstudy was performed. Sixty-four rabbits were divided into 4 groups, each ofcontaining 16 rabbits. In groups 1-3, 10 cm proximal to ileocecal valve theileum was transected and anastomosis was performed. In group 4, only laparotomywas performed. Animals received 20 ml 40% PEG-4000 in group 1, 20 ml 20%PEG-4000 in group 2, 20 ml saline solution in group 3 intraperitoneally. Eachgroup was divided into two subgroups, each containing 8 rabbits. On the 2ndpostoperative day in subgroups 1a, 2a, 3a after laraparotomy, 5cm proximal anddistal to previous anastomosis, ileal resection and ileoileal anastomosis, andin group 4a 10cm proximal to ileocecal valve a-10cm-ileal segment was resectedand anastomosis was performed. The same procedures were performed in subgroups1b, 2b, 3b, and 4b on the 7th postoperative day. Tissue hydroxyproline levelsand anastomotic brust pressures were measured in resected intestinal segments,and histopathologic examination was performed. Wound healing scores andhydroxyproline levels were significantly higher in group 4 compared to othergroups. 40% PEG-4000 has more negative effects on anastomotic healing on the2nd and 7th postoperative days compared to saline solution. There were nosignificant differences between 40% and 20% PEG-4000 solutions on the 2ndpostoperative day, but some significant ones on the 7th postoperative day.There were no significant differences between 20% PEG- 4000 and salinesolutions on the 2nd and 7th postoperative days. Further studies are needed toprove the clinical use of PEG-4000.

PEG-4000 Adezyon Anastomoz İnce Bağırsak Yara İyileşmesi

PEG-4000 Adhesion Anastomosis Smoll Bowel Wound Healing

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