Safra yolları anastomozunda absorbabl polyglycolic asid kaplı tüple onarım ile polypropylene sütürle onarımın striktür oluşumuna etkileri.
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Tarih
2024
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Necmettin Erbakan Üniversitesi, Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
Amaç: Biliyer sistem hastalıkları gastrointestinal sistem patolojilerin başında gelir. Safra kesesi ve safra yolları cerrahisi sonrası gelişen en önemli komplikasyonlardan birisi biliyer darlıklardır. Çalışmamızda sıçanlarda koledok kesilerinde poliprolen sütür materyali onarımı ile poliglikolik asit kaplı tüple onarımın biliyer striktür gelişimine etkisinin karşılaştırılması amaçlanmıştır.
Materyal Metod: Hayvan deneyi modelimizde 30(otuz) adet Wistar Albino cinsi dişi rat random olarak kullanıldı. Denekler random olarak 3(üç) gruba ayrıldı. Çalışma iki aşamalı cerrahi üzerinden planlandı. Birinci cerrahi basamakta deneklerin hepsinden preoperatif kan numuneleri alındı. Anestezi prosedürünü takiben laparotomi yapıldı. Ratların hepsinden 0.5 cm eksizyonel karaciğer biyopsileri alındı. Her grupta koledok distal anterior yüzünde kontrollü defekt oluşturuldu. Grup 1 de koledok defekti 8/0 poliglikolik asit ile primer onarıldı, Grup 2 de 8/0 polyproplen ile primer onarıldı, Grup 3 de koledok defekti 8/0 poliglicolidcolaktid (PGLA) ile primer onarıldıktan sonra etrafı emilebilir poliglikolik asit mesh tüp ile sarıldı. İkinci cerrahi basamakta, postoperatif 3. ayda yeniden tüm deneklerden kan numuneleri alındı. Ratlardan anestezi sonrası laparotomi yapılarak eksizyonel karaciğer biyopsileri alındı. Onarım yapılan koledok alanı rezeke edilerek histopatolojik değerlendirme için örnekleme yapıldı. Gruplar arasında koledok onarımı öncesi alınan karaciğer biyopsileri ile onarım sonrası 3. Ayda alınan karaciğer biyopsileri portal ödem, fibrozis, inflamasyon, safra kanalı proliferasyonu parametreleri incelenerek karşılaştırıldı. Gruplar arası koledok onarımı sonrası 3.ayda anastomoz hattı ve proksimal koledok kısmı ayrı ayrı rezeke edilerek çap oranları kameralı mikroskop ile mikron cinsinden ölçüm sonrası karşılaştırıldı. Koledok anastomoz alanlarının histopatolojik inceleme ile striktür yoğunlukları değerlendirildi.
Bulgular: Operasyon sonrası ALT ve GGT düzeyleri Grup 1’deki ratlarda diğer gruplardaki ratlara göre istatistiksel olarak anlamlı yüksek bulundu (p değerleri sırasıyla; p=0,036, p=0,017). Operasyon sonrası Grup 2’deki ratların ALP düzeyleri diğer gruplardaki ratlara göre istatistiksel olarak anlamlı düşük saptandı (p=0,049). Her üç grupta anastomoz ve proksimal çap ölçümleri istatistiksel olarak benzer tespit edildi. Oransal olarak en geniş çap 482,50±174,47 micron ile Grup 3 iken, en dar çap 377,85±100,53 micron ile Grup 1 olmuştur. Grupların koledok histopatolojik bulgularında her üç grupta polimorf, mononükleer hücre, proliferatif fibroblastlar ve kollajenskar dokusu oranları benzer olarak saptandı (p >0,05). Grup 3’te bulunan ratların %20’ında epitelyal hiperplazi varlığı tespit edildi. Grup 3’te oransal olarak proliferatif fibroblastlar ve kollajen skar dokusu diğer gruplara göre daha az görüldü. Grupların operasyon sonrası karaciğer histopatolojik bulgularında Grup 1 ve Grup 3’te bulunan ratların tamamında (n=10), Grup 2’de bulunan ratların %90’ında (n=9) inflamasyon varlığı tespit edildi. Her üç grupta fibrozis ve safra kanalı proliferasyonu varlığı benzer olarak bulundu (p>0,05). Grup 3’te bulunan ratlarda portal ödem olmama oranı grup 1 ve grup 2’deki ratlara göre istatistiksel olarak anlamlı yüksek bulundu (p=0,009). Grup 1’de bulunan ratların tamamında (n=10) postop dönemde portal ödem ve inflamasyon varlığı saptandı.
Sonuç: Çalışmamızda üç grubunda anastomoz çapları istatistiksel olarak benzer tespit edilmiş olup, kolanjiyografik ölçümlerin histolojik ölçümlerden daha optimal sonuç vereceğini düşünmekteyiz. Oransal olarak, prolen ile onarım yapılan ratların anastomoz çapı PGLA sütür ile onarım yapılan ratlardan geniş olmasına rağmen PGLA ile sütürasyon sonrası poliglikolik asit kaplı tüp kullanılan ratların anastomoz çaplarının en geniş olması poliglikolik asit kaplı tüplerin safra yolları onarımında striktürü azaltabileceğini düşündürmüştür. Daha önceki çalışmaların aksine nonabsorbable monoflaman sütür materyali olan prolenin transaminazlar ve kolestaz enzimlerini diğer gruplara göre anlamlı olarak daha az yükseltmesi striktür geliştirmeme açısından diğer sütür materyalinden üstün olabileceğini düşündürmüştür. PGA kaplı kondüitin bilindiğinin aksine inflamatuar süreçlere yol açabileceği düşünüyoruz.
Aim: Biliary system diseases are among the leading pathologies of the gastrointestinalsystem. One of the most important complications that develop after gallbladder and biliary tract surgery is biliarystenosis. Our study aimed to compare the effect of polyprolene suture material repair and polyglycolic acid-coated tube repair on biliary stricture development in common bile duct incisions in rats. MaterialandMethod: In our animal experiment model, 30 (thirty) femaleWistar Albino rats were randomly used. The subjects were randomly divided into 3 (three) groups. The study was planned through two-stagesurgery. Preoperative blood samples were taken from all subjects during the first surgical step. Following the anesthesia procedure, laparotomy was performed. 0.5 cm excisional liver biopsies were taken from all rats. A controlled defect was created on the distal anterior aspect of the common bile duct in each group. InGroup 1, the common bile duct defect was primarily repaired with 8/0 polyglycolicacid, in Group 2, it was primary repaired with 8/0 polypropylene, and in Group 3, the common bile duct defect was primarily repaired with 8/0 polyglycolidecolactide and then surrounded by an absorbable polyglycolicacid mesh tube. In the second surgical step, blood samples were taken from all subjects again at the 3rd postoperative month. After anesthesia, laparotomy was performed and excisional liver biopsies were taken from the rats. The repaired common bile duct area was resected and sampling was performed for histopathological evaluation. Liver biopsies taken before common bile duct repair and liver biopsies taken 3 months after repair were compared between the groups by examining portal edema, fibrosis, inflammationand bile duct proliferation parameters. At the 3rd month after the common bile duct repair between the groups, the anastomosis line and the proximal common bile duct were resected separately and the diameterratios were compared after measurement in micronswith a cameramicroscope. Stricture densities of common bile duct anastomosis are as were evaluated by histopathological examination. Findings: Post-operative ALT and GGT levels were found to be statistically significantly higher in therats in Group 1 than in therats in the other groups (p values; p = 0.036, p = 0.017, respectively). After the operation, the ALP levels of therats in Group 2 were found to be statistically significantly lower than the rats in the other groups (p = 0.049). Anastomotic and proximal diameter measurements were found to be statistically similar in all three groups. Proportionally, the widest diameter was Group 3 with 482.50±174.47 microns, while then arrowest diameter was Group 1 with 377.85±100.53 microns. In the common bile duct histopathological findings, the rates of polymorphous, mononuclearcells, proliferative fibroblasts and collagen scar tissue were found to be similar in all three groups (p > 0.05). Epithelial hyperplasia was detected in 20.0% of therats in Group 3. Proliferative fibroblasts and collagen scar tissue were seen proportionally less in Group 3 than in the other groups. In the post-operative liver histopathological findings of the groups, the presence of inflammation was detected in allrats in Group 1 andGroup 3 (n=10) and in 90.0% of rats in Group 2 (n=9). The presence of fibrosis and bile duct proliferation was found to be similar in all three groups (p>0.05). The rate of no portal edema in therats in group 3 was found to be statistically significantly higher than in therats in group 1 and group 2 (p = 0.009). The presence of portal edema and inflammation was detected in all rats in Group 1 (n=10) in the post operative period. Conclusion: In our study, anastomosis diameters were found to be statistically similar in the three groups, and we think that cholangiographic measurements will give more optimal results than histological measurements. Although proportionally, the anastomosis diameter of the rats repaired with prolene was larger than the rats repaired with PGLA suture, the largest anastomosis diameter of therats in which polyglycolicacid-coated tubes were used after suturing with PGLA suggested that polyglycolicacid-coated tubes may reduce stricture in bile duct repair. Contrary to previous studies, prolene, a non-absorbable monofilament suture material, increased transaminases and cholestasis enzymes significantly less than other groups, suggesting that it may be superior to other suture materials in terms of not developing stricture. We think that PGA-coated conduit may cause inflammatory processes, contrary to popular belief.
Aim: Biliary system diseases are among the leading pathologies of the gastrointestinalsystem. One of the most important complications that develop after gallbladder and biliary tract surgery is biliarystenosis. Our study aimed to compare the effect of polyprolene suture material repair and polyglycolic acid-coated tube repair on biliary stricture development in common bile duct incisions in rats. MaterialandMethod: In our animal experiment model, 30 (thirty) femaleWistar Albino rats were randomly used. The subjects were randomly divided into 3 (three) groups. The study was planned through two-stagesurgery. Preoperative blood samples were taken from all subjects during the first surgical step. Following the anesthesia procedure, laparotomy was performed. 0.5 cm excisional liver biopsies were taken from all rats. A controlled defect was created on the distal anterior aspect of the common bile duct in each group. InGroup 1, the common bile duct defect was primarily repaired with 8/0 polyglycolicacid, in Group 2, it was primary repaired with 8/0 polypropylene, and in Group 3, the common bile duct defect was primarily repaired with 8/0 polyglycolidecolactide and then surrounded by an absorbable polyglycolicacid mesh tube. In the second surgical step, blood samples were taken from all subjects again at the 3rd postoperative month. After anesthesia, laparotomy was performed and excisional liver biopsies were taken from the rats. The repaired common bile duct area was resected and sampling was performed for histopathological evaluation. Liver biopsies taken before common bile duct repair and liver biopsies taken 3 months after repair were compared between the groups by examining portal edema, fibrosis, inflammationand bile duct proliferation parameters. At the 3rd month after the common bile duct repair between the groups, the anastomosis line and the proximal common bile duct were resected separately and the diameterratios were compared after measurement in micronswith a cameramicroscope. Stricture densities of common bile duct anastomosis are as were evaluated by histopathological examination. Findings: Post-operative ALT and GGT levels were found to be statistically significantly higher in therats in Group 1 than in therats in the other groups (p values; p = 0.036, p = 0.017, respectively). After the operation, the ALP levels of therats in Group 2 were found to be statistically significantly lower than the rats in the other groups (p = 0.049). Anastomotic and proximal diameter measurements were found to be statistically similar in all three groups. Proportionally, the widest diameter was Group 3 with 482.50±174.47 microns, while then arrowest diameter was Group 1 with 377.85±100.53 microns. In the common bile duct histopathological findings, the rates of polymorphous, mononuclearcells, proliferative fibroblasts and collagen scar tissue were found to be similar in all three groups (p > 0.05). Epithelial hyperplasia was detected in 20.0% of therats in Group 3. Proliferative fibroblasts and collagen scar tissue were seen proportionally less in Group 3 than in the other groups. In the post-operative liver histopathological findings of the groups, the presence of inflammation was detected in allrats in Group 1 andGroup 3 (n=10) and in 90.0% of rats in Group 2 (n=9). The presence of fibrosis and bile duct proliferation was found to be similar in all three groups (p>0.05). The rate of no portal edema in therats in group 3 was found to be statistically significantly higher than in therats in group 1 and group 2 (p = 0.009). The presence of portal edema and inflammation was detected in all rats in Group 1 (n=10) in the post operative period. Conclusion: In our study, anastomosis diameters were found to be statistically similar in the three groups, and we think that cholangiographic measurements will give more optimal results than histological measurements. Although proportionally, the anastomosis diameter of the rats repaired with prolene was larger than the rats repaired with PGLA suture, the largest anastomosis diameter of therats in which polyglycolicacid-coated tubes were used after suturing with PGLA suggested that polyglycolicacid-coated tubes may reduce stricture in bile duct repair. Contrary to previous studies, prolene, a non-absorbable monofilament suture material, increased transaminases and cholestasis enzymes significantly less than other groups, suggesting that it may be superior to other suture materials in terms of not developing stricture. We think that PGA-coated conduit may cause inflammatory processes, contrary to popular belief.
Açıklama
Anahtar Kelimeler
Safra yolu striktürü, Bile ductstricture, polipropilen, polypropylene, poliglikolikasid kaplı tüple onarım, polyglycolic acid coated tube repair
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Bulut, O. (2024). Safra yolları anastomozunda absorbabl polyglycolic asid kaplı tüple onarım ile polypropylene sütürle onarımın striktür oluşumuna etkileri.. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Beyin Cerrahisi Anabilim Dalı, Konya.
