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1.
The traditional operative management of emergency distal colon pathology has involved staged procedures, but recently Hartmann's operation has gained popularity. The indications for primary anastomosis without covering colostomy have remained controversial, but the technique of on-table lavage has extended the use of this approach in the acute setting. A series of seven patients having this procedure for diverticular abscess (three), obstructing colonic carcinoma (one), perforating colonic carcinoma (one) and sigmoid volvulus (two) is presented. The saline irrigation is introduced by a Foley catheter inserted via the appendix stump and the effluent is diverted from the proximal colon by anaesthetic scavenger tubing. The lavage is continued until the effluent is clear and anastomosis performed with one-layer interrupted absorbable sutures. There were no deaths in the series; one patient developed a wound infection and average hospitalization was 16 days (range: 6-31 days). Immediate anastomosis in selected cases of emergency distal colonic pathology is thus feasible and safe following on-table colonic lavage. 相似文献
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Collagen metabolism was studied in the colonic wall of rats after standardized resection and anastomosis. Diminished faecal loading was obtained by feeding rats low-residue diet (Bisorbin MCT). The postoperative increase of collagen synthesis and collagen content was on a lower level in these rats than in rats on standard laboratory diet. The increase was confined to the immediate anastomotic region and presumably represented changes in collagen caused by the operative trauma per se. It was concluded that the intraluminal content is an important factor in stimulating collagen turnover. The findings of lower collagen turnover in the anastomotic area in animals on low-residue diet may have positive significance, but could also imply impairment of healing. For elucidation of this question, studies on mechanical strength of the anastomosis are necessary. 相似文献
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The possibility of preventing postoperative adhesions using phosphatidylcholine (PC) was studied in rats. A small bowel anastomosis was created using continuous or interrupted 5/0 silk sutures. Adhesions were measured by recording the maximal length of adhesions around the anastomosis and the number of organs involved in the adhesions. PC was administered intraperitoneally either as a single dose or as three separate doses. Postoperative adhesions developed in all animals; the degree of adhesion was independent of the suture technique used. PC given once at a dose of 20 mg significantly decreased adhesion formation (P less than 0.01). The mechanism underlying this effect may be that the exogenous PC provides a lubricant layer replacing endogenous hydrolysed phospholipid. The result with repeated PC administration was not different from that after a single dose. Increasing the single dose of PC to 40 or 60 mg resulted in anastomotic dehiscence and subsequent peritonitis. It is concluded that PC in a single dose of 20 mg reduces adhesion formation after small bowel anastomosis in the rat. 相似文献
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A programmed peritoneal lavage was done in 20 patients. During this lavage, tissue samples were withdrawn for histological control. During the therapeutical lavage, the morphological signs of inflammation decreased. For the sanitation of peritonitis, the cause of the disease must be eliminated. The morphological signs of healing start during the first three days postoperatively. Peritoneal repair prevails after the second or third postoperative day. Peritonitis will be lethal without focus sanitation and with microorganisms resisting any therapy, although lavage having been done. 相似文献
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The effect of continuous peritoneal irrigation on adhesion formation and survival rate was investigated in rats with faecal peritonitis induced by a caecal perforation. When no treatment was thereafter given, extensive adhesion formation and covering of the perforation were found at autopsy. Continuous peritoneal lavage did not increase the survival rate, but at autopsy no adhesion formation was seen and the perforation was wide open, permitting continued soiling. 相似文献
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Ziya Cetinkaya Kazim Esen Ibrahim Hanefi Ozercan Bilal Ustundag Refik Ayten Erhan Aygen 《World journal of emergency surgery : WJES》2006,1(1):37
Background
Ischemia is the most important factor compromises wound healing in colonic anastomosis. Mesenteric vessels are ligated at first while performing colonic resection and following anastomosis. Therefore blood supply of the related segments of colon temporarily interrupted and ischemia can easily occur. This study was carried out to explore whether Bosentan, an endothelin-receptor antagonist, can eliminate vasoconstruction, increase blood flow in the splanchnic area and anastomotic region and therefore possibly facilitate wound healing and prevent intra-abdominal adhesion formation. 相似文献9.
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The breaking strength of anastomoses in the left colon in the early phase of healing was studied in rats fed low residue diet (Biosorbin MCT) and the results were compared to those from rats fed standard laboratory diet. Further, eventual correlation between mechanical strength development and collagen content in the colonic wall around the anastomosis was evaluated. The anastomotic strength with sutures in place decreased by approximately 30% of the immediate postoperative value during the first two days in both groups of animals. There was no correlation between changes in anastomotic strength and collagen content at that time. After the second day there was a gradual increase of anastomotic strength, reaching the strength at day 0 after 7 days. The regain of strength was mainly due to collagen deposition in the anastomosis. Despite more collagen deposition in animals on standard laboratory diet the anastomoses had comparable strength development in the two groups. It was concluded that low residue diet does not impair the suture holding capacity or the anastomotic strength. Instead there was some evidence for a more uncomplicated healing when the bowel content was diminished. 相似文献
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Kumano H Tanaka Y Yamada Y Yamamoto Y Kamiya T Ishimura N Nishiwada M 《Masui. The Japanese journal of anesthesiology》2003,52(7):722-728
BACKGROUND: The effect of steroids against inflammatory mediators is well known, but its benefit and adverse effect on the postoperative clinical course are uncertain after esophageal resection for carcinoma. METHODS: Forty-three cases undergoing esophageal resection for carcinoma were studied retrospectively. Twenty-six cases, given corticosteroids during operation or first postoperative day, were classified as the steroid group, and the other 17 cases were defined as the control group. Postoperative courses, complications, and outcomes were compared between these 2 groups. RESULTS: In the steroid group, heart rate, body temperature and C-response protein were depressed during the postoperative period, and duration of systemic inflammatory response syndrome was 1.2 +/- 1.1 days compared with 2.7 +/- 1.4 days in the control group (P < 0.001). Although the duration of mechanical ventilation and ICU stay was unchanged, morbidity rate of postoperative anastomotic leakage was 15% in the steroid group compared with 47% in the control group (P < 0.05). The other morbidity rates of pulmonary complications, postoperative infection, arrhythmia, and liver dysfunction as well as mortality rate were similar between the 2 groups. CONCLUSIONS: Corticosteroids given in the early postoperative period depress systemic inflammatory response and attenuate the rate of postoperative anastomotic leakage after esophageal resection for carcinoma. 相似文献
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A C van der Ham W J Kort I M Weijma H F van den Ingh J Jeekel 《The British journal of surgery》1991,78(1):49-53
Fibrin adhesives have been advocated as a protective seal in colonic anastomosis to prevent leakage. In order to assess the effect of fibrin glue sealing we compared the healing of sutured colonic anastomosis in the rat (group 1) with the addition of human-derived fibrin sealant (group 2). As a control for a possible reaction to foreign protein, in group 3 the sutured anastomosis was sealed with specially prepared rat fibrin adhesive. On days 2, 4 and 7, ten animals in each group were killed. Adhesion formation was scored and the in situ bursting pressure was measured. The collagen concentration and degradation were estimated by measuring hydroxyproline. Adhesion formation was significantly increased in groups 2 and 3 compared with the control group. On days 2 and 7 the bursting pressure was not different between the groups. On day 4 the bursting pressure in groups 2 and 3 was significantly lower than in group 1 (P less than 0.001). These findings correspond with the results of collagen measurements. On day 4 the concentration of hydroxyproline was significantly reduced in groups 2 and 3. Histological examination showed infiltration of neutrophilic granulocytes into the sealant on days 2 and 4; on day 7 the sealant had vanished. From these results it is concluded that fibrin sealing of the colonic anastomosis in the rat does not improve healing, as demonstrated by bursting pressure and hydroxyproline concentration. On the contrary, it seems to have a negative influence. 相似文献
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Reijnen MM Holmdahl L Kooistra T Falk P Hendriks T van Goor H 《The British journal of surgery》2002,89(1):103-109
BACKGROUND: This study assessed the peritoneal fibrinolytic response during the first week after colonic surgery in rats with and without bacterial peritonitis, and possible modulation of the response by two hyaluronan-based antiadhesive agents. METHODS: A colonic anastomosis was constructed in 90 male Wistar rats. Peritonitis was induced in another 108 rats and a colonic anastomosis was constructed after 24 h. Rats in both groups were randomized into an untreated group or one of two groups treated with hyaluronan-based agents. One-third of each group was killed at each of days 1, 3 and 7 after operation, and tissue plasminogen activator (tPA) antigen and activity were measured in peritoneal biopsies. RESULTS: One day after colonic surgery in normal rats, tPA antigen concentration was significantly (P < 0.005) increased, whereas tPA activity levels were normal. By day 3 after operation tPA antigen had returned to baseline values while tPA activity was significantly increased (P < 0.05). One day after inducing peritonitis tPA antigen was significantly increased (P < 0.001), while tPA activity was significantly reduced (P < 0.05). Three and seven days after colonic surgery in rats with peritonitis tPA activity was increased (P < 0.001) while tPA antigen had returned to baseline values. Neither of the hyaluronan-based agents affected peritoneal tPA antigen levels or activity after colonic surgery. CONCLUSION: Both abdominal surgery and infection caused an early increase in peritoneal tPA antigen levels, followed by an increase in tPA activity. Peritonitis severely depressed early tPA activity. Application of hyaluronan-based agents did not affect the peritoneal fibrinolytic response to surgery and/or infection. 相似文献
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The treatment of generalized peritonitis by closed postoperative peritoneal lavage. A critical review of the literature 总被引:1,自引:0,他引:1
Thirty-nine studies of closed postoperative peritoneal lavage were reviewed, including four prospective, randomized studies, eight nonrandomized comparative studies, and 27 noncomparative studies. Mortality rates and abscess rates were determined for various subsets of patients. Despite the large number of studies performed, the therapeutic value of this procedure remains unknown. It is unlikely that further noncomparative or nonrandomized studies will yield useful information. There remains a need for a large-scale, prospective, randomized study to evaluate closed postoperative peritoneal lavage. Smaller prospective, randomized studies can contribute meaningfully if data on the specific causes of peritonitis, severity of disease, and patient age and chronic health status are provided in the form of widely used and well-validated stratification systems. 相似文献
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-arginine methyl ester (L-NAME) on the healing of colonic anastomosis in the presence of a left-sided obstruction in the rat was investigated. Left-sided
colonic obstruction was created in 144 Wistar rats. The obstruction site was excised 24 h later and anastomosis was performed
after either no irrigation or colonic lavage with either saline, povidone iodine (PI), short-chain fatty acids (SCFA), L-NAME, or glutamine, in 24 animals each. Animals were killed on days 3 and 6, and a 4-cm colonic segment with the anastomosis
at the center was excised. Bursting pressure (BP) and hydroxyproline (HP) content were measured. In the saline, PI, and SCFA
groups, BP was higher (P < 0.05, P < 0.05, and P < 0.001, respectively) and HP concentration was similar compared with controls. Both the BP and HP concentrations were higher
in the glutamine group compared with controls (P < 0.001). BP was lower (P < 0.05) and HP concentration was similar in the L-NAME group compared with the control group. Colonocyte nutrition and tissue perfusion are the mainstays of anastomotic healing.
Intraoperative colonic lavage with L-NAME suppresses colonic anastomotic healing in the presence of a left-sided obstruction.
(Received for publication on Mar. 29, 1999; accepted on Nov. 11, 1999) 相似文献