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- Jahnson, S, et al.
(författare)
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Anastomotic blood-flow reduction in rat small intestine with chronic radiation damage.
- 1998
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Ingår i: Digestion. - 0012-2823 .- 1421-9867. ; 59:2, s. 134-41
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/AIMS: Anastomoses in previously irradiated intestine are prone to leakage, possibly due to an impeded blood supply. Whether or not chronic radiation damage actually predisposes to a disturbed blood flow in the vicinity of anastomoses was investigated in the rat small bowel.METHOD: A 2-cm segment of rat ileum was irradiated with a single dose (21 Gy). After 20 weeks an anastomosis was created in the irradiated segment and in the corresponding segment of controls. Another 4 days later local blood flow was studied with the 14C-iodoantipyrine autoradiography technique in 16 sectors around the circumference both in the anastomotic segment and in a segment 4 mm apart.RESULTS: In the anastomotic segment, the average blood flow was reduced in irradiated compared with non-irradiated animals in the mucosal layer (p = 0.034), but not in the muscular layer (p = 0.08). In the mesenteric quadrant blood flow was reduced in irradiated compared with non-irradiated animals, both in the mucosal layer (p = 0.012) and in the muscular layer (p = 0.05). More irradiated than non-irradiated animals showed a blood-flow reduction to 15% or more in 13-16 sectors both in the mucosal (p = 0.015) and the muscular layer (p = 0.04).CONCLUSIONS: The results favor the hypothesis that anastomoses in previously irradiated intestine are vascularly compromized and thereby have an increased risk of leakage.
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| 2. |
- Jahnson, S, et al.
(författare)
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Anastomotic breaking strength and healing of anastomoses in rat intestine with and without chronic radiation damage.
- 1995
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Ingår i: European Journal of Surgery. - 1102-4151 .- 1741-9271. ; 161:6, s. 425-30
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess the influence of chronic radiation damage on anastomotic healing in the small bowel in rats.DESIGN: Controlled laboratory study.SETTING: University hospital, Sweden.MATERIAL: 90 male Sprague-Dawley rats.INTERVENTIONS: A short segment of the distal ileum was exteriorised and irradiated with a single dose (experimental group, n = 45) or exposed only (control group, n = 45). Twenty weeks later resection and anastomosis were done within this segment using 7/0 polypropylene.MAIN OUTCOME MEASURES: The anastomotic breaking strength, the amount of perianastomotic hydroxyproline, and the number of anastomotic complications.RESULTS: The breaking strength and the amount of perianastomotic hydroxyproline were higher in the irradiated than in the non-irradiated group. In contrast, anastomotic complications were significantly more common in irradiated animals.CONCLUSION: Anastomotic complications in irradiated intestine are not related to the amount of perianastomotic collagen or to breaking strength.
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| 6. |
- Jahnson, S, et al.
(författare)
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Prognosis of surgically treated radiation-induced damage to the intestine.
- 1992
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Ingår i: European Journal of Surgical Oncology. - 0748-7983 .- 1532-2157. ; 18:5, s. 487-93
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Tidskriftsartikel (refereegranskat)abstract
- A series of 88 patients operated on during 24 years for radiation-induced damage (RID) to the intestinal tract were retrospectively reviewed and clinical and surgical factors were related to the ultimate prognosis by multivariate analysis. The first operation was performed on the small intestine in 47 patients, the large intestine in 32 patients or both in nine patients. Postoperative complications occurred in 35 patients (40%), with fatal outcome in 12 (13%). Thirty-one patients (35%) required further surgery and altogether 19 patients (22%) ultimately died from RID. Negative prognostic factors after the first operation were postoperative intestinal leak (P < 0.05) and operation for fistula or perforation (P < 0.01). The outcome after the last operation was negatively influenced by intestinal leak (P < 0.001) by the choice of bypass as operative procedure (P < 0.01) and by operation for fistula or perforation (P < 0.01). In addition, 43% of the patients in whom the disease had progressed between two explorations died from RID. Thus, the severity of the RID as diagnosed at laparotomy, and progression of the disease between two subsequent explorations were related to the prognosis. Care should be taken to avoid intestinal leak. Resections should be preferred to bypass of injured intestine whenever possible.
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