Karaciğer Parankim Kanaması Oluşturulan Sıçanlarda Topikal Hemostatik Ajanların Hemostatik Etkinliğinin Değerlendirilmesi
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Tarih
2022
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Karaciğerin travmatik yaralanmalarında veya karaciğer ameliyatlarında mortalitenin en sık nedeni olan kanamalarda, topikal hemostatik ajanların etkinliğini karşılaştırarak mortalite ve morbidite oranlarının azalmasını sağlamaktır.
Materyal ve Metod:Randomize kontrollü çalışma olarak planlanan deneysel modelimizde 24 adet dişi Wistar Albino cinsi rat kullanıldı. Ratlar kendi içinde rastgele üç gruba ayrıldı. Tüm gruplardan preoperatif kan örnekleri alındı. Tüm gruplara genel anestezi altında laparotomi yapıldı ve karaciğer sol lateral lobuna anatomik olmayan rezeksiyon uygulandı. Kontrol grubunda (Grup 1) rezeksiyon yüzeyine % 0.9 NaCl solüsyonu, Grup 2 de rezeksiyon yüzeyine oksitlenmiş rejenere sellüloz (ORS) içerikli emilebilir hemostatik toz (Surgicel® Powder), Grup 3 de rezeksiyon yüzeyine fibrin doku yapıştırıcısı (Tisseel®) uygulandı. Postoperatif 24. saatte yeniden tüm gruplardan kan örnekleri alındı. Preoperatif ve postoperatif hemotokrit (Hct) ve hemoglobin (Hb) değerleri ölçülerek karşılaştırma yapıldı.Cerrahi girişimden 5 gün sonra genel anestezi altında rezeksiyon alanından histopatolojik değerlendirme için örnekleme yapıldı.
Sonuçlar:Bu çalışmada kontrol, ORS ve fibrin yapıştırıcı kullanılan gruplar arasındaki Hct ve Hb değerleri arasındaki farklar karşılaştırıldı. Bu değerler arasındaki farka bakıldığında fibrin yapıştırıcı ve ORS kullanılan grup ile kontrol grubu arasında istatistiksel olarak anlamlı fark tespit edildi. Histopatolojik değerlendirmede; ORS ve fibrin yapıştırıcı kullanılan grup ile kontrol grubu arasında istatistiksel olarak anlamlı fark tespit edilmedi. Ancak fibrin yapıştırıcının oransal olarak daha fazla nekroza yol açtığı görüldü. Ayrıca ORS bileşiklerinin antimikrobiyal etkilerinin olmasına rağmen ORS kullanılan grupta abse oluşumu görüldü.
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Tartışma:Karaciğer kanamalarında ORS ve fibrin yapıştırıcının hemostatik olarak etkili olduğu, ancak fibrin yapıştırıcının istatistiksel olarak anlamlı olmamasına rağmen karaciğer parankiminde oransal olarak daha fazla nekroza yol açtığı tespit edildi.
The aim is to reduce the mortality and morbidity rates by comparing the effectiveness of topical hemostatic agents in bleeding, which is the most common cause of mortality in liver traumatic injuries or liver surgeries. Material and Method: In our experimental model, which was planned as a randomized controlled study, 24 female Wistar Albino rats were used. Rats were randomly divided into three groups.. Preoperative blood samples were taken from all groups.All groups underwent laparotomy under general anesthesia and non-anatomical resection of the left lateral lobe of the liver was performed. In the control group (Group 1), 0.9% NaCl solution was applied to the resection surface, in Group 2, absorbable hemostatic powder (Surgicel® Powder) containing oxidized regenerated cellulose (ORS) was applied to the resection surface, and in Group 3, fibrin tissue adhesive (Tisseel®) was applied to the resection surface.Blood samples were taken from all groups again at the postoperative 24th hour. Preoperative and postoperative hematocrit (Hct) and hemoglobin (Hb) values were measured and compared.5 days after the surgical intervention, sampling was performed from the resection area for histopathological evaluation under general anesthesia Results: In this study, the differences in Hct and Hb values between control, ORS and fibrin glue groups were compared. Considering the difference between these values, a statistically significant difference was found between the group using fibrin glue and ORS and the control v group. In histopathological evaluation; There was no statistically significant difference between the ORS and fibrin glue group and the control group. However, it was observed that fibrin glue caused proportionally more necrosis. In addition, although ORS compounds have antimicrobial effects, abscess formation was observed in the ORS group. Conclusion: ORS and fibrin glue were found to be hemostatically effective in hepatic hemorrhages, but fibrin glue caused proportionally more necrosis in the liver parenchyma, although it was not statistically significant.
The aim is to reduce the mortality and morbidity rates by comparing the effectiveness of topical hemostatic agents in bleeding, which is the most common cause of mortality in liver traumatic injuries or liver surgeries. Material and Method: In our experimental model, which was planned as a randomized controlled study, 24 female Wistar Albino rats were used. Rats were randomly divided into three groups.. Preoperative blood samples were taken from all groups.All groups underwent laparotomy under general anesthesia and non-anatomical resection of the left lateral lobe of the liver was performed. In the control group (Group 1), 0.9% NaCl solution was applied to the resection surface, in Group 2, absorbable hemostatic powder (Surgicel® Powder) containing oxidized regenerated cellulose (ORS) was applied to the resection surface, and in Group 3, fibrin tissue adhesive (Tisseel®) was applied to the resection surface.Blood samples were taken from all groups again at the postoperative 24th hour. Preoperative and postoperative hematocrit (Hct) and hemoglobin (Hb) values were measured and compared.5 days after the surgical intervention, sampling was performed from the resection area for histopathological evaluation under general anesthesia Results: In this study, the differences in Hct and Hb values between control, ORS and fibrin glue groups were compared. Considering the difference between these values, a statistically significant difference was found between the group using fibrin glue and ORS and the control v group. In histopathological evaluation; There was no statistically significant difference between the ORS and fibrin glue group and the control group. However, it was observed that fibrin glue caused proportionally more necrosis. In addition, although ORS compounds have antimicrobial effects, abscess formation was observed in the ORS group. Conclusion: ORS and fibrin glue were found to be hemostatically effective in hepatic hemorrhages, but fibrin glue caused proportionally more necrosis in the liver parenchyma, although it was not statistically significant.
Açıklama
Anahtar Kelimeler
Karaciğer parankim kanamaları, Topikal hemostatik ajanlar, Oksitlenmiş rejenere sellüloz, Fibrin doku yapıştırıcısı, Liver parenchyma hemorrhages, Topical hemostatic agents, Oxidized regenerated cellulose, Fibrin tissue adhesive
Kaynak
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Scopus Q Değeri
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Künye
Acar, B. (2022). Evaluatıon Of The Hemostatıc Effectıveness Of Topıcal Hemostatıc Agents In Rats Wıth Lıver Parenchymal Hemorrhage. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Genel Cerrahi Anabilim Dalı, Konya.
