Ratlarda iskemik kolon anastomozunun iyileşmesine papaverinin etkisi

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Kolorektal cerrahi ve diger gastrointestinal sistem cerrahileri gozonune alindiginda anastomoz kacaklari onemli bir sorun olusturmaktadir. Cerrahi teknikte, anestezide, preoperatif hazirlikta ve postoperatif bakimdaki tum teknolojik gelismelere ragmen anastomoz kacaklari halen yuksek oranda mortalite ve morbidite sebebidir. Ozellikle kolon iskemisi ve mezenter iskemi durumlarinda yapilan anastomozlar da bu risk daha da artmaktadir. Bu durumlarda olusan iskemireperfuzyon hasari yara iyilsemesini de kotu etkilemektedir. Anastomoz iyilesmesine katkida bulunan onemli faktorlerden bir de doku kanlanmasidir. Iskemi-reperfuzyon hasari sonrasi dokuda olusan mikrovaskuler yatakta vazokonstruksiyon kisir dongusunu kirmak amaciyla bircok madde denenmistir. Bu calismanin amaci vazodilatator ve antispazmodik etkileriyle yaygin kullanim alanina sahip olan papaverinin iskemik kolon anastomozlarinin iyilesmesi uzerine olan etkilerini arastirmaktir. Calismada 40 adet, 8-10 haftalik Wistar-Albino soyuna ait disi rat kullanildi. Her biri 10? ar hayvan bulunduran 4 adet grup olusturuldu. 1. grup; kontrol grubu, 2. grup; iskemi-reperfuzyon sonrasi anastomoz grubu, 3. grup; iskemi-reperfuzyon sonrasi anastomoz ve tek doz intraperitoneal papaverin grubu, 4. Grup; iskemireperfuzyon sonrasi anastomoz ve gunluk intraperitoneal papaverin grubu olarak belirlendi. 1. gruba anestezi verilmesini takiben cekumun 3 cm distali cikan kolon transekte edilerek ucuca anastomoz edildi. 2. gruba anestezi verilmesini takiben cekum ve cikan kolon mezosu mikrovaskuler klemplerle klempenerek 60 dakika iskemi ve 60 dakika reperfuzyon uygulandi. Iskemi ve reperfuzyonu takiben cekumun 3 cm distali cikan kolon transekte edildi ve ucuca anastomoz edildi. 3. gruba 2. gruptaki islemlere ek olarak anastomoz sonrasi intraperitoneal 60 mg/kg papaverin uygulandi. 4. Gruba 3. gruba ek olarak postoperatif 10 gun boyunca intraperitoneal gunluk 60 mg/kg papaverin uygulandi. Postoperatif 10. Gunde tum ratlar sakrifiye edilerek anastomoz patlama basinclari olculdu. Anastomoz hattindan alinan parcalara patolojik inceleme ve hidroksiprolin olcumu yapildi.37 Calismanin istatistiksel analizi Ankara Universitesi Tip Fakultesi Biyoistatistik Anabilim Dali? nda yapildi. Anastomoz patlama basinclari, hidroksiprolin duzeyleri ve patolojik iyilesme skorlari acisindan karsilastirma yapildiginda hem tek doz intraperitoneal papaverin hem de gunluk intraperitoneal papaverin grubuyla iskemi-reperfuzyon grubu arasinda istatistiksel olarak anlamli farklar saptandi. Tek doz intraperitoneal papaverin ve gunluk intraperitoneal papaverin gruplari arasinda ise hidroksiprolin duzeyleri disinda istatistiksel olarak anlamli fark bulunmadi. Sonuc olarak papaverinin iskemi-reperfuzyon sonrasi yapilan anastomozlarda iyilesmeye katki sagladigi goruldu. Ilerleyen donemlerde daha genis gruplarla ve daha cok parametre kullanilarak deney yapilmasi daha net ve guvenilir sonuclar saglayacaktir. Abstract Anastomotic leak is already the most devastating complication after colorectal surgery and other gastrointestinal tract surgeries. Altought the technological improvements in surgical technique, anesthesia, preoperative preperation and postoperative care; the anastomotic leak result with high mortality and morbidity rates. Especially in colonic ischemia and mesenteric ischemia setting, this risk becomes higher because of the ill effects of ischemia-reperfusion injury on the healing process. The blood supply is very important factor in anastomotic healing. Many molecules tested to break the vicious cycle of microvascular bed vasoconstruction after ischemia-reperfusion injury. Papaverine, a vasodilatatory and antispasmodic agent has long been used in many ischemic conditions setting for its potentially protective effects. The aim of this study is to investigate the effects of papaverine on healing colon anastomosis. Eight- to ten- weeks- old female, forty, Wistar-Albino rat were used for this study. The rats were randomised in four groups, every group included ten animals. Groups defined as, 1. group; control group, 2. group; ischemia-reperfusion and anastomosis group, 3. group; ischemia-reperfusion and anastomosis + intraperitoneal one dose papaverine group, 4. group; ischemia-reperfusion and anastomosis + intraperitoneal Daily(ten days) papaverine group. After administration of anestesia to 1. group, the ascenden colon distal to 3 cm from ceacum transected and end-to-end anastomosis was made. After administration of anesthesia to 2. group, after sixty minutes ischemia with microvasculer clips on mesocolon and sixty minutes reperfusion, the ascendend colon distal to 3 cm from ceacum transected and end-toend anastomosis was made. After administration of anesthesia to 3. group, in additionally the group 2, intraperitoneal papaverine injection was made. After administration of anesthesia to 4. group, in additionally the group 3, daily intraperitoneal papaverine injection was made postoperatively ten days. After ten days all rats were sacrifised and anastomotic bursting pressures were measured. The 39 hydroxyproline measurement and histopathological examination was made from the parts of the anastomosis. The statistical analysis was made in Ankara University Medicine Faculty Department of Biostatistics. There was statically significant difference in group three and four from group two for anastomotic bursting pressures, hydroxyproline measurements and anastomotic healing scores of histopathological examination. There was no statically significant difference in group tree from group four except hydroxyproline measurements. In conclusion, there was significant good effects of papaverine on healing of anastomosis after ischemia-repefusion injury. In later periods, with larger groups and more parameters, experiments will provide clearer and more reliable results.