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

Yıl 2006, Cilt: 13 Sayı: 1, 7 - 12, 01.02.2006

Gülsen Ekingen Canan Ceran Arzu Demirtola Billur Demiroğulları Banu Sancak Aylar Poyraz Kaan Sönmez A.can Basaklar Nuri Kale

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Kaynakça

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