Authors: Pengfei Wang Jian Wang Wenbo Zhang Yousheng Li Jieshou Li
Publish Date: 2009/01/10
Volume: 33, Issue: 3, Pages: 567-576
Abstract
Intraabdominal sepsis and hemorrhagic shock have been found to impair the healing of intestinal anastomoses The present study examined whether fibrin glue FG and recombinant human growth hormone GH can improve intestinal primary anastomotic healing in a pig model of traumatic shock associated with peritonitis Further the study was designed to investigate the probable mechanism of these agentsFemale anesthetized pigs were divided into five groups Group sham n = 7 pigs without traumatic shock had small bowel resection anastomoses group control n = 14 pigs had bowel resection anastomoses 24 h after abdominal gunshot plus exsanguination/resuscitation group FG n = 14 group GH n = 14 group FG/GH n = 14 pigs received FG recombinant GH or both respectively Recombinant GH was given daily for 7 days Blood samples were collected daily for measurement of interleukin6 IL6 and tumor necrosis factor TNFα levels Investigations also included adhesion formation anastomotic bursting pressure tensile strength hydroxyproline HP content myeloperoxidase MPO tumor necrosis factor NFκB activity and histology analysis 10 days later A second experiment n = 20 subjects assigned to each of the five groups was designed to study survival during the first 20 postoperative daysTraumatic shock associated with peritonitis led to significant decreases in intestinal anastomotic bursting pressures tensile strengths and tissue hydroxyproline content along with severe adhesion formation increases in MPO activity and NFκB activity and plasma levels of tumor necrosis factor alpha TNFα and interleukin6 IL6 Both FG and recombinant GH treatment led to early significant increases in plasma levels of TNFα and IL6 At the same time FG alone unlike recombinant GH alone led to significant increases in anastomotic bursting pressures tensile strength and tissue HP content along with decreases in anastomotic MPO and NFκB activity and later plasma levels of TNFa and IL6 The FG group also developed more marked neoangiogenesis and collagen deposition on histology analysis However FG and recombinant GH synergistically effected improved anastomotic healing abolishing the infaust effects promoted by recombinant GH Adhesion formation after intestinal anastomosis could not be lowered by FG alone or by the combination of FG and recombinant GH Both FG alone and FG/GH in contrast to GH alone and control treatment significantly prolonged the survival time of experimental animalsWe found that FG but not recombinant GH could lower the risk of anastomotic leakage improve intestinal anastomotic healing and prolong survival in a pig model of traumatic shock associated with peritonitis Both FG and recombinant GH synergistically effected improved intestinal anastomotic healing It was suggested that GH could be used locally to promote intestinal anastomotic healing in intra–abdominal peritonitis
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