20 января 2019г.
Abstract. The formation of a safe anastomosis is the main key element for operations on the organs of the digestive tract accompanied by resection. However, despite the improvement of surgical techniques, as well as the use of innovative technologies and medicines, the suture leakage of the intestinal anastomosis remains high, especially in acute peritonitis. It is still difficult today to control regeneration processes in tissue structures after mechanical damage [1, с. 426]. The operation outcome, including the development of complications, depends largely on it. The purpose of the work is to study the rate of such regeneration, as well as the functional and biochemical state of tissue structures of the colonic anastomosis under uncomplicated conditions and in acute peritonitis [1, с. 52].
Аннотация. Создание надежного соустья является главным, ключевым элементом операций на органах пищеварительного тракта, сопровождающихся резекцией. Однако, несмотря на совершенствование оперативной техники, применения новых технологий и лекарственных средств, несостоятельность швов кишечного анастомоза остается высокой, особенно при остром перитоните. На сегодняшний день до сих пор остается вопрос об управлении регенерацией в тканевых структурах после механического повреждения. От нее во многом зависит исход операции, в частности развитие осложнений. Целью работы является изучение темпа регенерации и функционально-биохимическое состояние тканевых структур толстокишечного анастомоза в неотягощенных условиях и при остром перитоните.
Keywords: colonic anastomosis, peritonitis, phospholipase activity, redox potential
Ключевые слова: толстокишечный анастомоз, перитонит, фосфолипазная активность, редокс- потенциал
Currently, the issue of regeneration processes in tissue structures after mechanical damage has not been resolved yet. At the same time, the issue of metabolic changes in the tissues of regenerating structures, which cause a violation of such regeneration, remains poorly known [4, с. 190]. The work is based on the results of experimental studies in 25 adult dogs, which were divided into 2 groups. The first group studied the morphofunctional states of tissues and healing of the colonic anastomosis under uncomplicated conditions; while the second group performed the same studies in conditions of acute peritonitis.
Materials and methods. The first group studied the morphofunctional states of tissues and healing of the colonic anastomosis under uncomplicated conditions; while the second group performed the same studies in conditions of acute peritonitis. We took anesthetized animals of the first group and performed resection of the colon followed by the formation of the Albert-Lembert double layer anastomosis, while animals from the second group were operated under acute peritonitis, which was simulated by injecting fecal masses into the abdominal cavity, followed by the main operation that was performed the next day. We used such methods as: macroscopy of autopsy; light (optical) microscopy haematoxylin and eosin staining; determination of redox potential for studying tissue electrogenesis; determination of oxygen diffusion coefficients in tissues based on the decreasing rate of the diffuse recovery voltage according to the Epstein's equation; determination of veno-venous gradient according to Landis; determination of the blood amount in tissues of clavate (quilled) suture of intestinal anastomosis; determination of the intensity of tissue lipid peroxidation using TBC test; the activity of phospholipase A2 was investigated by the catalytic activity of the enzyme during the formation of free fatty acids defined by the potentiometric method; superoxide dismutase activity was evaluated in the reaction with nitroblue tetrazolium; dissection of cadaveric material; observation of animals in the postoperative period. method; superoxide dismutase activity was evaluated in the reaction with nitroblue tetrazolium; preparation of cadaveric material; observation of animals in the postoperative period.
Results and their discussion. In the first group, we studied the reparative process of the colonic anastomosis under uncomplicated conditions. We used the research methods that allowed us to assess the state of metabolic processes in the tissue structures of the colonic anastomosis. For this purpose, biophysical and biochemical research methods were applied.
We took anastomosis tissues and measured the redox potential, the diffusion capacity of tissues for oxygen, assessed the degree of tissue blood supply, as well as studied the intensity of lipid peroxidation processes, the state of antioxidant potential and phospholipase A2 activity [5, с. 91]. We found out some hypotrophic disorders occurred in the tissues along the anastomotic suture line. Moreover, we noted a sharp decrease in the redox potential, decrease in the diffusion capacity of tissues for oxygen, increase in the blood supply of tissues indicating the increased vascular permeability of the microvasculature (or microcirculatory bloodstream). Wherein, the regeneration of studied parameters was only by 5-7 days.
Against the background of an impaired blood supply to anastomosis tissues and hypoxia onset, there was an increased activity of lipid peroxidation, activation of phospholipase A2, decrease in antioxidant potential as evidenced by a decrease in the activity of superoxide dismutase. Against the background of developed metabolic disorders, the regeneration process of anastomosis tissues in most cases proceeded according to the secondary intension or adhesion with the formation of ulcerous defects along the suture line.
In the second group, we studied the process of regeneration and the morphofunctional state of tissues of the colonic anastomosis in animals with acute peritonitis. Of course, acute peritonitis causes pronounced disorders of microcirculation in the intestine, which is a serious burden factor of the reparative process. Therefore, we were faced with the task of studying the microcirculation and trophism of tissues of anastomose sections of the colon in acute peritonitis. It turned out that against the background of peritoneum inflammation, there is a decrease in the redox potential, serious disorders of transcapillary metabolism expressed in increased production of capillary filtrate and loss of protein [6, с. 115]. These processes led to an increase of tissue blood supply and a decrease of their diffusion capacity for oxygen.
There is no doubt that after the formation of a colonic anastomosis under these conditions, more pronounced trophic disorders develop in its tissue structures, in comparison with the control under acute peritonitis there was a significantly more pronounced decrease in the redox potential, decrease in the diffusion coefficient of oxygen, increase in blood supply observed in anastomosis tissues [3, с. 45]. Under the established trophic conditions a more pronounced activity of lipid peroxidation processes occurred in anastomosis tissues. We also note a sharp increase in phospholipase activity of tissue structures along the suture line. These pathological processes were the basis of expressed morphological changes in the anastomosis zone, up to necrosis of tissues along the entire suture line. This caused the secondary anastomotic healing and the frequent failure of the reparative process with the development of suture failure or leakage in 26.7% (in 4 out of 15 animals).
Changes in redox potential (ORP), diffusion coefficient of oxygen (D), the blood supply to tissues (K) colonic anastomosis in uncomplicated conditions.
* - reliability with respect
to the norm at p<0.05
The content of TBA-active products in the tissues colonic anastomosis in acute peritonitis
Activity of superoxide dismutase in tissues colonic anastomosis in acute peritonitis
\
Activity of phospholipase
A2 in tissues colonic anastomosis in acute peritonitis
Conclusion. Based on data obtained from these studies, we found out that the unfavorable healing of the double layer anastomosis under peritonitis is based on a dramatic violation of tissue trophism, activation of free- radical lipid peroxidation processes and phospholipase activity, which reduces reparative potential of tissues. So, one of the key pathophysiological factors leading to a disorder in the process of anastomosis regeneration in acute peritonitis is the process of lipid peroxidation and increased activity of phospholipase systems.
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