Köpeklerde ince ve kalın barsak arasındaki anastomozlarda mekanik ve mikrobiyolojik reflüyü önleyen invagine nipple valve uygulaması
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Date
1996
Authors
Kızıldağlı, H. Özlem Nisbet
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Publisher
Uludağ Üniversitesi
Abstract
İleosekal valfin gastrointestinal sistem içerisindeki fizyolojik fonksiyonu çok önemlidir. Valfin varlığı nedeni ile ince ve kalın barsak arasında büyük oranda kalitatif ve kantitatif mikro- biyel farklılıklar vardır. İleosekal valfi içeren masif rezeksiyonlarda ortaya çıkan klinik komplikasyonlann giderilmesine yönelik olarak çeşitli teknikler geliştirilmiştir. Biz de bu çalışmada ileosekal valfin eksize edilmesi halinde oluşturulacak "invagine nipple valve"in mekanik ve bakteriyel kolo-ileal reflüyü önlemedeki rolünü araştırdık. Bu çalışma 8'erli gruplar halindeki 24 adet melez deneme köpeği üzerinde yürütüldü. 1. gruptaki olgularda " invagine nipple valve", 2. gruptaki olgularda "klasik uç uca anastomoz"uygulandı. 3. grup kontrol grubu olarak kullanıldı. 1. grupta yer alan 8 deney köpeğinden biri 30. günde meydana getirilen valfin patolojik hale geçmesi sebebi ile ötenazi edildi. Başka bir deney köpeği çalışmaya alınarak sayı 8'e tamamlandı. 2. ve 3. gruplarda bir komplikasyona rastlanmadı. 18. ve 90. günler arasında yapılan radyolojik muayenelerde 1. ve 3. gruptaki olgularda retrograd yönde mekanik reflüye rastlanmazken, 2. gruptaki tüm olgularda reflü tespit edildi. Her üç gruptaki deney hayvanlarının hem kaudal ileumundan hem de colon ascen- dens'in kranialinden alınan flora örnekleri operasyon sonrası aerob total bakteri sayılan açısın dan karşılaştırıldı. 1. ve 3. gruptaki köpeklerin kalın barsaklanndaki total bakteri sayısının ince barsaklardakine oranla biraz daha fazla olduğu, 2. grupta ise bu sayının hemen hemen eşit düzeyde olduğu görüldü. Bu sonuçların istatistiki olarak önemli olduğu tespit edildi. l"İnvagine nipple valve"in bakteriyel reflüyü engellemede yeterli olup olmadığını sap tamak amacı ile belirleyici bakteri olarak seçilen S. thyphymurium kalın barsak içerisine enjekte edildi. 2 gün sonra ince barsaktan alınan numunelerden yapılan analizlerde 1. ve 3. grupta bak teriye rastlanmazken, 2. gruptaki köpeklerin hepsinde az ya da çok miktarda tespit edilmiştir. Post mortem olarak yapılan makroskopik muayenelerde valfin olduğu bölgede dilatas- yon veya stenoza rastlanmamıştır. Operasyon sırasında 4 cm olan nipple valve'in 20. ile 70. günler arasında yapılan post mortem muayenelerde 2,5-3 cm olduğu gözlenmiştir. Histopatolojik muayenelerde "invagine nipple valve"in dikiş hattındaki epitelizasyonun 5. haftadan sonra şekillendiği tespit edilmiştir. Yaptığımız çalışma sonucunda "invagine nipple valve"in mekanik ve bakteriyel reflüyü engellemede etkili olması ve kolay uygulanabilir olması nedeni ile ileosekal valfi içeren masif rezeksiyonlarda tercih edilebilecek bir yöntem olduğunu düşünmekteyiz.
Ileocecal valve has an important physiological function in the gastrointestinal system. There are great qualitative and quantitative differences between the small and large bowel microflora due to an intact ileocecal valve. Various techniques are developed for prevention of clinical complications of massive resection including ileocecal valve. This study was carried out to determine the efficiency of an experimental "invaginated nipple valve" after the excision of the ileocecal valve on prevention of mechanical and bacterial coloileal reflux. In this study a total of 24 mongrel dogs were used as materials and they were divided into three groups, each consists of 8 dogs. "invaginated nipple valve" and classical end to end anastamosis were applied in the first and second groups. The third group was left for control. One dog in the 1. group was euthanasied because of pathological changes on the valve and another dog was taken into the group. There were no complications in the other groups. Based on the radiological examinations on 18.-90. days there was no mechanical retrograd reflux in the 1. and 3. groups; reflux was detected in all cases of the 2. group. Postoperatively, microflora examples of each dog, collected from both distal ileum and proximal colon ascendence, were compared for aerobic total bacterial counts. Total bacterial count of the large bowel were slightly higher than in the small bowel in the 1. and 3. groups. Differences were found statistically significant. Total bacterial count of the large and small bowels were nearly the same in the 2. group. S.typhimirium was injected into the large bowel, choosen as marker bacteria to determine if "invaginated nipple valve" is sufficient to prevent bacterial reflux. On the analysis of examples collected from the small bowel, there were no bacteria in the 1. and 3. group but there were some bacteria in the 2. group on the 2. day postoperatively. 3At necropsy, there was macroscopically no evidence of dilatation or stenosis in the region of the valve. It was observed that the length of the nipple was smaller (2.5-3 cm.) postoperatively than the initial length (4 cm). Histopathologically, epithelisation of the "nipple valve" was observed on the suture line after 5 weeks. It was concluded that "nipple valve" can be choosen during the massive resection including ileocecal valve because of its efBcency on the prevention of mechanical and bacterial reflux and its easy application
Ileocecal valve has an important physiological function in the gastrointestinal system. There are great qualitative and quantitative differences between the small and large bowel microflora due to an intact ileocecal valve. Various techniques are developed for prevention of clinical complications of massive resection including ileocecal valve. This study was carried out to determine the efficiency of an experimental "invaginated nipple valve" after the excision of the ileocecal valve on prevention of mechanical and bacterial coloileal reflux. In this study a total of 24 mongrel dogs were used as materials and they were divided into three groups, each consists of 8 dogs. "invaginated nipple valve" and classical end to end anastamosis were applied in the first and second groups. The third group was left for control. One dog in the 1. group was euthanasied because of pathological changes on the valve and another dog was taken into the group. There were no complications in the other groups. Based on the radiological examinations on 18.-90. days there was no mechanical retrograd reflux in the 1. and 3. groups; reflux was detected in all cases of the 2. group. Postoperatively, microflora examples of each dog, collected from both distal ileum and proximal colon ascendence, were compared for aerobic total bacterial counts. Total bacterial count of the large bowel were slightly higher than in the small bowel in the 1. and 3. groups. Differences were found statistically significant. Total bacterial count of the large and small bowels were nearly the same in the 2. group. S.typhimirium was injected into the large bowel, choosen as marker bacteria to determine if "invaginated nipple valve" is sufficient to prevent bacterial reflux. On the analysis of examples collected from the small bowel, there were no bacteria in the 1. and 3. group but there were some bacteria in the 2. group on the 2. day postoperatively. 3At necropsy, there was macroscopically no evidence of dilatation or stenosis in the region of the valve. It was observed that the length of the nipple was smaller (2.5-3 cm.) postoperatively than the initial length (4 cm). Histopathologically, epithelisation of the "nipple valve" was observed on the suture line after 5 weeks. It was concluded that "nipple valve" can be choosen during the massive resection including ileocecal valve because of its efBcency on the prevention of mechanical and bacterial reflux and its easy application
Description
Keywords
Barsak anastomozlan, Intestinal anastomosis, Mekanik reflü, Bakteriyel reflü, "Nipple valve", Köpek, Mechanical reflux, Bacterial reflux, Dog
Citation
Kızıldağlı, H. Ö. N. (1996). Köpeklerde ince ve kalın barsak arasındaki anastomozlarda mekanik ve mikrobiyolojik reflüyü önleyen invagine nipple valve uygulaması. Yayınlanmamış doktora tezi. Uludağ Üniversitesi Sağlık Bilimleri Enstitüsü.