Ratlarda intraabdominal adhezyonları önlemede fibrinolitik ajanların etkinliklerinin karşılaştırılması
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Date
2007
Authors
Topal, Ersun
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Abdominal cerrahi, belirgin morbidite ve mortalitenin eşlik ettiği intraabdominal adezyonlara neden olabilir. Yapılan çalışmalara rağmen adezyonlardan korunmada etkin bir profilaksi henüz mevcut değildir. Adezyon oluşumundaki fizyopatolojik mekanizmaların başında, peritoneal fibrinolitik aktivitenin azalması yada yetersiz kalması sonucu peritoneal fibrinolizin hasar görmesi gelir. Ratlar üzerinde yapılan bu çalışmada, fibrinolitik sistemde farklı noktalardan etkili üç ajanın, adezyonları önlemede etkinlikleri ve birbirlerine üstünlükleri araştırıldı. Gereç ve yöntem: Her grupta 10 adet, dört farklı grupta 40 adet dişi Wistar- Albino rat kullanıldı. Standart anestezi ve laparotomiyi takiben, çekumda serozal defekt oluşturuldu. Kontrol grubunda (Grup 1) tedavi uygulamaksızın, karın kapatılırken; ikinci grupta (Grup 2) karın kapatıldıktan sonra Fondaparinuks Sodyum (FS) yedi gün boyunca tek doz, subkutanöz uygulandı. Üçüncü grupta (Grup 3) karın kapatılmadan önce doku Plazminojen Aktivatörü (DPA) intraperitoneal uygulandı. Dördüncü grupta (Grup 4) karın kapatılmadan önce, aktive Drotrekogin alfa (ADA) intraperitoneal uygulandı. Tüm gruplarda postoperatif 14. günde relaparotomiyi takiben adezyonlar makroskopik olarak skorlandı. Histopatolojik inceleme için, adezyonlardan ve çekum serozal yüzeyden alınan doku örneklerinde enflamasyon, neovaskülarizasyon ve fibrozis skorlanarak değerlendirildi. Kontrol grubuna göre, Makroskopik adezyon skoru (MAS) (p=0.002), enflamasyon (p=0.047), kollajen akümülasyonu (KA), (p=0.005) ve fibrozis (p=0.03) oluşumunda istatistiksel anlamlı farklılıklar mevcuttu. ii Sonuç: ADA, peritoneal fibrinolitik sistem üzerinde FS ve DPA ile benzer şekilde etki göstererek adezyonları engellemekte ve ayrıca enflamasyon ve fibrozis üzerine olan belirgin etkileri nedeniyle diğer ajanlara üstün gibi görünmektedir
The abdominal surgery may cause intra-abdominal adhesions accompanied by significant morbidity and mortality. Although the presence of numerous studies, any proflaxis to prevent adhesion is not available yet. Diminished or insufficient peritoneal fibrinolitic activity resulting impaired peritoneal fibrinolizis is the leading physiopathological mechanism in adhesion formation. Three agents affecting fibrinolitic system on different steps were compared by efficacy to prevent adhesions and by superiority to each other in this rat model. Materials and method: Wistar Albino type 40 female rats divided four groups of 10 rats were included in this study. A serozal defect was performed after anesthesia and subsequent laparotomy for each rat. In the second group (Group 2), Fondaparinux sodium (FS) was applied once a day after closure of abdomen by subcutaneous way for seven days while there was no therapy in control group (Group 1). Tissue Plasminogen Activator (TPA) was administered intraperitoneal cavity before closure in the third group (Group 3). In the fourth group (Group 4), Activated Drotrecogin alfa (ADA) was applied intraperitoneally before closure of abdomen. Results: The adhesions were scored by macroscopy performed subsequental to relaparotomy on the postoperative 14th day of the first laparotomy in all groups. Inflammation, neovascularisation and fibrosis were evaluated by scoring histopathologically on the tissue samples from adhesions and seroza of caecum. There were significant differences according to control group in macroscopic iv adhesion score (MAS) (p=0.002), inflammation (p=0.047), kollagen accumulation (KA) (p=0.005) and fibrosis formation (p=0.03). Conclusion: ADA prevents adhesions by affecting fibrinolitic system similar to FS and DPA and appears superior to other agents because of having significant effects on inflammation and fibrosis.
The abdominal surgery may cause intra-abdominal adhesions accompanied by significant morbidity and mortality. Although the presence of numerous studies, any proflaxis to prevent adhesion is not available yet. Diminished or insufficient peritoneal fibrinolitic activity resulting impaired peritoneal fibrinolizis is the leading physiopathological mechanism in adhesion formation. Three agents affecting fibrinolitic system on different steps were compared by efficacy to prevent adhesions and by superiority to each other in this rat model. Materials and method: Wistar Albino type 40 female rats divided four groups of 10 rats were included in this study. A serozal defect was performed after anesthesia and subsequent laparotomy for each rat. In the second group (Group 2), Fondaparinux sodium (FS) was applied once a day after closure of abdomen by subcutaneous way for seven days while there was no therapy in control group (Group 1). Tissue Plasminogen Activator (TPA) was administered intraperitoneal cavity before closure in the third group (Group 3). In the fourth group (Group 4), Activated Drotrecogin alfa (ADA) was applied intraperitoneally before closure of abdomen. Results: The adhesions were scored by macroscopy performed subsequental to relaparotomy on the postoperative 14th day of the first laparotomy in all groups. Inflammation, neovascularisation and fibrosis were evaluated by scoring histopathologically on the tissue samples from adhesions and seroza of caecum. There were significant differences according to control group in macroscopic iv adhesion score (MAS) (p=0.002), inflammation (p=0.047), kollagen accumulation (KA) (p=0.005) and fibrosis formation (p=0.03). Conclusion: ADA prevents adhesions by affecting fibrinolitic system similar to FS and DPA and appears superior to other agents because of having significant effects on inflammation and fibrosis.
Description
Keywords
İntra-abdominal adezyonlar, Drotrekogin-alfa, Fondaparinuks, DPA, Korunma, Intra-abdominal adhesions, Drotrecogin alfa, Fondaparinux, TPA, Preventing
Citation
Topal, E. (2007). Ratlarda intraabdominal adhezyonları önlemede fibrinolitik ajanların etkinliklerinin karşılaştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.