Sildenafil Sitratın Kolon Anastomozundaki Yara İyileşmesi Üzerine Etkisi

Yıl 2007, Cilt: 1 Sayı: 2, 66 - 75, 15.07.2007

Adnan Hasanoğlu

Öz

Kolon anastomoz kaçakları cerrahide önemli morbidite ve mortalite nedenleridir. Bunları minimale indirmek için bir çok çalışma yapılmış, bir çok yöntem denenmiş, bir çok ilaç kullanılmış ancak halen anastomoz kaçakları sorun olmaktan çıkmamıştır. Bu çalışmada, deneysel olarak bir çok çalışmada düz kas gevşemesi etkisinden yararlanılarak olumlu sonuçlar elde edilmiş sildenafil sitratın kolon anastomozlarındaki yara iyileşmesi üzerine etkisinin araştırılması amaçlandı.

Her birinde 6 rat bulunan 4 grup oluşturuldu. 1.gruba anastomoz yapılıp postop 3.gün anastomoz patlama basıncı, perianastomotik doku hidroksiprolin düzeyi ve perianastomotik doku histopatolojik değerlendirme skorlarına bakıldı. 2.gruba 1 hafta boyunca feeding sonda ile oral 10 mg/kg/gün sildenafil sitrat verilip anastomoz yapılarak postop 3.gün yine aynı parametreler değerlendirildi. 3.gruba anastomoz yapılıp postop 7.gün aynı parametreler bakıldı. 4.gruba da 1 hafta boyunca feeding sonda ile oral 10mg/kg/gün dozunda sildenafil sitrat verilerek postop 7.gün anastomoz patlama basıncı, perianastomotik doku hidroksiprolin düzeyi ve perianastomotik doku histopatolojik değerlendirme skorlarına bakıldı.
Patlama basınçları ilaç verilen gruplarda verilmeyen gruplardan anlamlı derecede yüksek bulunmuştur (p<0.05). Perianastomotik doku hidroksiprolin değerlerinde istatistiksel olarak anlamlı bir fark yoktu. Histopatolojik değerlendirmede ise mukozal hasar, submukozalmusculer tabaka hasarı ve toplam skorda ilaç verilen gruplar lehine anlamlı istatistiksel fark bulunmaktaydı (p<0.05).

Sonuç olarak sildenafil sitrat verilen gruplardaki anastomoz patlama basınçlarındaki artışlar ve histopatolojik yara iyileşmesi toplam skorlarındaki olumlu düzelmeler Sildenafil sitratın kolon anastomozlarında yara iyileşmesine katkısı olabileceğini düşündürdü.

Abstract
Leakage of colonic anastomosis is an important factor for mortality and morbidity in surgery. In this article, we investigate the effect of sildenafil citrate on colonic anastomosis healing, by using its smooth muscle dilatator effect. This is an experimental animal study. 24 rats were separated into 4 groups and each had 6 rats. In the 1st group the colon was anastomosed. Anastomosis bursting pressure, the level of perianastomotic tissue hydroxiprolin, and the score of histopathological evaluation of perianastomotic tissue were measured on the postoperative 3rd day. In the 2nd group colon was anastomosed after 1 week of oral 10 mg/kg/day sildenafil citrate treatment by feeding sonda. Same parameters were investigated on the postoperative 3rd day. In the 3 rd group same parameters were investigated 7 days after the colonic anastomosis operation. In the 4th group colon was anastomosed after 1 week of oral 10 mg/kg/day sildenafil citrate treatment by feeding sonda and 7 days after the operation anastomosis bursting pressure, the level of perianastomotic tissue hydroxiprolin, the score of histopathological evaluation of perianastomotic were measured. Bursting pressures were significantly higher in the groups that the drug was given than the groups that was not given (p<0.05). There was no significant difference between the groups according to the level of perianastomotic tissue hydroxiprolin. Histopathological evaluation revealed significant difference between the groups on damage at mucosa, submucosa- muscular layer and total score. As a result, bursting pressures of anastomosis and total scores of wound-healing improved at the groups that sildenafil citrate were given, so we concluded that sildenafil citrate may have a contribution on the healing of wound at colonic anastomosis.

Anahtar Kelimeler

Sildenafil sitrat, yara iyileşmesi, kolon

Kaynakça

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