Ameliyat sonrası gelişen karın içi yapışıklıkların önlenmesinde metilen mavisinin etkinliğinin histopatolojik olarak değerlendirilmesi: Deneysel bir çalışma

Erkan Hazar, Metin Şen, Sedat Çiftel, Ersin Tuncer
1.194 785

Abstract


Özet

Amaç. İntestinal tıkanıklıkların önemli bir nedeni ameliyat sonrası yapışıklıklardır. Bu çalışmanın amacı, metilen mavisinin ameliyat sonrası yapışıklıkları önleyici etkilerini araştırmaktır. Yöntem. Matür 40 adet sıçan kullanılıp, ameliyat öncesi sıçanlar rastgele olarak her biri 10 sıçandan oluşan 4 gruba ayrıldı. I. Gruba çekum ön duvarında 0,5 cm’lik alan 15 no lu bistüri ile travmatize edilerek, II. Gruba çekum ön duvarda 1 cm’lik alana bistüri ile tam kat kesildi ve kapatıldı. Bu iki gruba karın içerisine 2 mL SF konuldu. III. Gruba çekum ön duvarında 0,5 cm’lik alan 15 no’lu bistüri ile travmatize edilerek, IV. Gruba çekum ön duvarda 1 cm’lik alana bistüri ile tam kat kesildi ve kapatıldı. Bu iki gruba da karın içerisine %1’lik metilen mavisinden 2 mL konuldu. Ameliyat sonrası 14. günde çekumdan histopatolojik inceleme için biyopsi alınarak fıbrozis, neovaskülarizasyon, ve inflamasyon dereceleri incelendi. Bulgular. Fibrozis bakımından; 2 ve 4. Gruplar tamamen pozitif (+), 1. Grubun %80’i negatif (-) olarak değerlendirildi. İnflamatuar cevap için hastaların %25’i negatif (-), %75’i pozitif (+)’tir. 2. Grup için tamamı %100’ü pozitif (+)’tir. Neovaskülarizasyon bakımından, tüm hastaların %35’i negatif (-) %65’i pozitif (+)’tir. Her gruptan en az bir hasta negatifken en çok 1. Grupta %70 negatif (-) hasta vardır. Mezotel hücre proliferasyonu bakımından, hastaların %27.5’i negatif,%62.5’i pozitif(+)’tir. Grup 1’de negatiflik(-) oranı %80, grup3’te pozitiflik oranı %90, grup 4 için deneklerin tamamı pozitiftir. Sonuç. Metilen mavisinin fıbrozisi, neovaskülarizasyonu ve inflamasyonu azaltmadığı, mezotel hücre proliferasyonunu azalttığı görüldü. Bu bulgular, metilen mavisinin mezotel hücre proliferasyonunu azaltarak ameliyat sonrası yapışıklıkları önleyebileceğini desteklemektedir"

Anahtar sözcükler: Ameliyat sonrası gelişen yapışıklıklar, metilen mavisi

 

Abstract

Aim. Post-operative adhesions are a major cause of intestinal obstructions. The aim of this study is to investigate the effects of methylene blue on preventing post-operative adhesions. Methods. Forty mature rats were used. They were randomly divided into four groups of 10 rats. In group I, 0.5 cm area at the front side of the caeceum was traumatized using a No: 15 lancet, in group II the front side of the caeceum was cut through for 1 cm by lancet and closed. In both groups 2 ml of saline was added into the abdomen. In group III 0.5cm area at the front side of the caeceum was traumatized using a No: 15 lancet, in group IV the front side of the caeceum was cut through for 1 cm by lancet and closed. In both groups 2 mL of 1% methylene blue was added into the abdomen. On the postoperative 14th day biopsy was taken for histopathological examination; at which degrees of fibrosis, neovascularization and inflammation were evaluated. Results. By means of fibrosis; the second and fourth groups found to be completely positive while eighty percent of the first group was negative. By means of inflammatory response, twenty-five of the patients were negative while seventy-five percent of them were positive. All of the patients in the second group were positive. By means of neovascularization; thirty-five percent of all patients were negative while sixty-five of them were positive. While at least one patient from each group was negative; seventy percent of the patients in the first group being the largest number of patients when compared with the other groups were negative. By means of mesothelial cell proliferation; 27.5 percent of the patients was negative while 62.5 percent of the patients was positive. The negativity ratio of group 1 was 80%, while it was 90% for group 3 and it was positive for all of the patients in group 4. Conclusion. We found that methylene blue does not decrease fibrosis, neovascularization and inflammation but it was found to decrease mesothelial cell proliferation. These findings suggest that methylene blue can decrease post-operative adhesions by decreasing mesothelial cell proliferation.

Keywords: Post-operative adhesions, methylene blue

Keywords


Post-operative adhesions, methylene blue

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