Postoperatif perikardiyal adezyonları önlemede biyoemilebilir polilaktid bariyerin etkinliğinin tavşan modelinde araştırılması
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Date
2008
Authors
Gürbüz, Orçun
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Publisher
Uludağ Üniversitesi
Abstract
Postoperatif retrosternal ve intraperikardiyal adezyonlar resternotomiyi, cerrahi ekip için, tehlikeli ve zaman alıcı hale getirir. Bu problemi çözmek için, farklı perikardiyal materyaller kullanılarak, birçok çalışma yapılmıştır. Ancak, bu materyallerin klinik faydalarını gösteren kesin kanıt olmadığından, hiçbirisi rutin kullanıma geçmemiştir. Bu çalışmanın amacı biyoemilebilir polilaktid tabakanın postoperatif perikardial adezyonları önlemedeki etkinliğini araştırmaktır.Yeni Zelanda beyazı kırk tavşan onarlı dört gruba ayrıldı. Sol anterior torakotomiyi takiben perikardiyotomi yapıldı ve kalbin anterolateral yüzeyine karegaz ile epikardiyal abrazyon uygulandı. Kontrol gruplarında, grup 1 ve 2, perikard retrosternal adezyonlara imkan sağlamak için açık bırakıldı. Tedavi gruplarında, grup 3 ve 4, 0,02 mm'lik transparan biyoemilebilir polilaktid tabaka perikarda yerleştirildi ve 6/0 prolen ile fiske edildi. Postoperatif makroskopik ve mikroskopik değerlendirmeler, grup 1 ve 3'te 3 hafta sonra, grup 2 ve 4'te 6 hafta sonra yapıldı.Emilebilir perikardiyal materyal 3 hafta sonra tamamen emilmişti. Adezyon, inflamatuar reaksiyon ve fibröz reaksiyon skorları, kontrol ve tedavi grupları karşılaştırıldığında anlamlı farklı değildi. Ancak, mikroskopide tüm tedavi gruplarında görüldüğü üzere, polilaktid tabaka yeni mezotel benzeri hücre tabakası gelişimine yardımcı oldu.Polilaktid tabaka perikardiyal adezyonların gelişimini önlemedi ancak kabuk görevi görerek perikardiyal rejenerasyona ve mezotel benzeri hücre tabakası gelişimine yardımcı oldu.
Postoperative retrosternal and intrapericardial adhesions make a repeat sternotomy time consuming and dangerous for the surgical team. Several studies have been made to resolve this problem by using different types of pericardial substitutes. However, none of them have yet been routinely applicable in the clinical setting, as solid clinical evidence on their benefical effects is absent. The purpose of this study was to evaluate the efficacy of a bioabsorbable polylactide film for preventing postoperative pericardial adhesions.Forty New Zealand white rabbits were divided into for groups of ten. After performing a left anterior thoracotomy, a pericardiotomy was made and epicardial abrasions were done on the anterolateral surface of the heart with gauze. İn control groups, group1 and 2, the pericardium was left open to allow retrosternal adhesions. İn treatment groups, group 3 and 4, 0,02 mm transparent bioabsorbable polylactid film was placed inside the pericardium and 6/0 prolen sutures were used to fix it. Postoperative macroscopic and microscopic evaluations were made at 3 weeks in group1 and 3, at 6 weeks in group2 and 4, after implantation.The absorbable pericardial subtitude was completely absorbed by 3 weeks after implantation. There were no significant differences in adhesion, inflamatuar reaction and fibrous reaction scores, between control and treatment groups. However, polylactid film supported the growth of new mesothelium like layer, as microscopy showed in all treatment groups.Polylactid film did not prevent development of pericardial adhesions but may has served as a scaffold for the regeneration of pericardium and the growth of mesothelium like layer.
Postoperative retrosternal and intrapericardial adhesions make a repeat sternotomy time consuming and dangerous for the surgical team. Several studies have been made to resolve this problem by using different types of pericardial substitutes. However, none of them have yet been routinely applicable in the clinical setting, as solid clinical evidence on their benefical effects is absent. The purpose of this study was to evaluate the efficacy of a bioabsorbable polylactide film for preventing postoperative pericardial adhesions.Forty New Zealand white rabbits were divided into for groups of ten. After performing a left anterior thoracotomy, a pericardiotomy was made and epicardial abrasions were done on the anterolateral surface of the heart with gauze. İn control groups, group1 and 2, the pericardium was left open to allow retrosternal adhesions. İn treatment groups, group 3 and 4, 0,02 mm transparent bioabsorbable polylactid film was placed inside the pericardium and 6/0 prolen sutures were used to fix it. Postoperative macroscopic and microscopic evaluations were made at 3 weeks in group1 and 3, at 6 weeks in group2 and 4, after implantation.The absorbable pericardial subtitude was completely absorbed by 3 weeks after implantation. There were no significant differences in adhesion, inflamatuar reaction and fibrous reaction scores, between control and treatment groups. However, polylactid film supported the growth of new mesothelium like layer, as microscopy showed in all treatment groups.Polylactid film did not prevent development of pericardial adhesions but may has served as a scaffold for the regeneration of pericardium and the growth of mesothelium like layer.
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Keywords
Kalp cerrahisi, Perikardiyal adezyonlar, Biyoemilebilir polilaktid tabaka, Cardiac surgery, Pericardial adhesions, Bioabsorbable polylactid film
Citation
Gürbüz, O. (2008). Postoperatif perikardiyal adezyonları önlemede biyoemilebilir polilaktid bariyerin etkinliğinin tavşan modelinde araştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.