表皮生长因子对肠吻合口愈合影响的实验研究

目的　探讨重组人表皮生长因子 (rhEGF)对家兔小肠吻合口愈合的促进作用。方法　将 4 8只实验兔随机均分为实验组及对照组 ,均行近端小肠部分切除再吻合术 ,实验组动物于吻合时行rhEGF黏膜下注射。行外周血WBC计数 ,观察吻合口胶原纤维及羟脯氨酸的合成以及吻合口漏发生率。结果　两组术后 3d、5d及 7d与术前比较WBC略有升高 ,但差异无显著性意义 (P>0 .0 5 )。实验组吻合口漏发生率为 4 .3% ,而对照组为16 .7%。实验组术后 3d、5d及 7d胶原纤维面积密度较对照组明显增多 ,吻合口周围成纤维细胞明显增多 ,核大、浓染且胞浆丰富。实验组吻合口组织新生血管较多且有正常腺管结构 ,而对照组黏膜细胞结构破坏重。羟脯氨酸生成在术后 5d及 7d实验组与对照组相比差异有显著性意义 (P<0 .0 5 )。结论　炎症反应存在于创伤修复的全过程 ,但EGF局部应用对全身炎性反应的影响不大。rhEGF有促进创伤愈合、细胞向创面迁移的作用 ,使成纤维细胞增多 ,胶原纤维合成及转运加快 ,同时促进创面新生血管产生 ,可有效促进吻合口的愈合 ,防止吻合口漏的发生。

Effect of Recombinant Epidermal Growth Factor on Small Bowel Anastomotic Wound Healing

Objective To study the positive effect of recombinant human epidermal growth factor (rhEGF) on rabbit intestinal anastomotic wound healing after bowel resection. Methods Forty eight white rabbits were randomly divided into study group in which rhEGF was injected and spinged in the submucosa and mucosa respectively during intestinal anastomosis after bowel resection, and control group in which only intestinal resection and anastomosis was performed. The leukocyte was counted. The incidence of anastomotic leakage and the synthesis of collagen fibrils and hydroxyproline were observed. Results The leukocyte numbers in the anastomotic tissue in two groups rabbits increased slightly 3 d, 5 d and 7d after intestinal anastomosis, but the difference between study group and control group was insignificant ( P >0.05). The incidence of anastomotic leakage in the control group (16.7%) was higher than that of the study group (4.3%). The area of collagen fibrils 3 d, 5 d and 7d after intestinal anastomosis in the study group were significantly more than that in the control group ( P <0.05). Number of fibroblast was higher in the study group and the cells appeared bigger nucleus and dense colouration as well as enriched plasm. Angiogenesis in anastomosis tissue in the study group was significant and normal structure was present. Cell structure of anastomosis mucosa was damaged in the control group. Synthesis of hydroxyproline in anastomotic tissue 5 d and 7 d after anastomosis in the study group was more than that in the control group ( P <0.05).Conclusion Inflammation was present in the whole process of wound healing, and local using of EGF had insignificant effect on system inflammation. EGF functions as chemoattractant and increases the recruitment of leukocytes, monocytes and fibroblasts into the wound area. EGF increases the production of collagen, angiogenesis and the synthesis of hydroxyproline. So EGF could promote wound healing and protect from anastomosis leakage in this study.