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술전 방사선 및 화학약물 치료 후 수술시기에 따른 대장문합부의 견고성

Effects of Preoperative Chemoradiotherapy on the Healing of Colonic Anastomosis with the Lapse of Operation Time in the Rat

대한대장항문학회지 1999년 15권 1호 p.21 ~ 30
윤성수 ( Yun Sung-Soo ) - 영남대학교 의과대학 외과학교실

김동식 ( Kim Dong-Sik ) - 영남대학교 의과대학 외과학교실
김춘직 ( Kim Chun-Jik ) - 영남대학교 의과대학 외과학교실
김상운 ( Kim Sang-Woon ) - 영남대학교 의과대학 외과학교실
김재황 ( Kim Jae-Hwang ) - 영남대학교 의과대학 외과학교실
서보양 ( Suh Bo-Yang ) - 영남대학교 의과대학 외과학교실
심민철 ( Shim Min-Chul ) - 영남대학교 의과대학 외과학교실
권굉보 ( Kwun Koing-Bo ) - 영남대학교 의과대학 외과학교실
성언기 ( Sung Eon-Ki ) - 영남대학교 의과대학 해부학교실

Abstract


Purpose: Preoperative chemoradiotherapy has become an important adjunct in the management of rectal cancer. But both systemic toxicity of chemotherapy and local effect of radiation interfere wound healing of intestinal anastomosis and ultimately may lead to anastomotic leak and septic complications. The purpose of this study is to determine the optimal time interval between preoperative chemoradiotherapy and anastmotic construction, and it was evaluated by security of anastomotic construction.

Methods: One hundred and twenty male Sprague Dawley rats weighing approximately 250 g were randomly divided into 4 groups (Control group; n=40, Group 1; n=20, Group 2; n=20, Group 3; n=40). The control group (n=20) underwent anastomotic construction at 1 week after general anesthesia without preoperative chemoradiotherapy. The experimental animals (group 1, 2, 3) received preoperative chemoradiotherapy with 5 daily dose (20 mg/kg) of 5-fluorouracil and single dose of 1500 cGy radiation at the rectosigmoid junction under general anesthesia on the day after last dose of chemotherapy. And group 1∼3 subsequently underwent a laparotomy to make anastomotic construction at 1 week (Group 1), 2 weeks (Group 2), and 3 weeks (Group 3; n=20) after completion of chemoradiotherapy. The security of anastomotic construction was determined by bursting pressure, tissue hydroxyproline content, gross and microscopic
findings of anastomotic area at the 5th and 10th postoperative day after anastomotic construction. To evaluate systemic toxicity after chemoradiotherapy, serial body weight and alteration of CBC were measured in the control group (n=20) and Group 3 (n=20) without anastomotic construction.

Results: At the 5th postoperative day, Mean bursting pressures of the all treated groups were lower than that of the control group (Control group; 88 23 mmHg, Group 1; 49 22 mmHg, Group 2; 56 17 mmHg, Group 3; 78 23 mmHg). The
difference was not significant in the group 3 compared with the control group. Body weightdecreased in the all treated animals. The mean body weight was lowest on the day 8 after completion of chemoradiotherapy and then it gradually increased. WBC and platelet counts also decreased in the all treated animals. WBC count was lowest on the day 1 and platelet count was lowest on the day 3 after completion of chemoradiotherapy. Mean hydroxyproline contents at the anastomotic sites in the all treated groups were higher than that of the control group, especially in the group 2 and 3. Similar histologic changes were observed in both group 3 and control group.

Conclusion: The results suggest that the optimal time interval for safe intestinal anastomosis after preoperative chemoradiotherapy is 3 weeks or later.

키워드

Preoperative chemoradiotherapy;Bursting pressure;Hydroxyproline;Anastomotic construction
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