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Pooperační monitorace kolorektální anastomózy – experimentální studie


Authors: J. Kalvach 1,2;  O. Ryska 2,3;  J. Pazin 1,2;  J. Hadac 1,2;  S. Juhas 2;  J. Juhásová 2;  J. Martínek 2,4,5,6;  M. Ryska 1,7
Authors‘ workplace: Department of Surgery, nd Faculty of Medicine, Charles University and Central Military Hospital, Prague 1;  Institute of Animal Physiology and Genetics, Czech Academy of Science, PIGMOD, Liběchov 2;  Royal Lancaster Infirmary, University Hospitals of Morecambe Bay, NHS foundation Trust Lancaster, United Kingdom 3;  Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine Prague 4;  Medical Faculty of the University Hospital Ostrava 5;  Institute of Physiology, 1st Faculty of Medicine, Charles University, Prague 6;  Faculty of Health and Social Care University of Medicine Trnava, Slovakia 7
Published in: Rozhl. Chir., 2018, roč. 97, č. 5, s. 202-207.
Category: Original articles

Overview

Úvod:
Nedostatečné krevní zásobení představuje jeden z hlavních rizikových faktorů dehiscence anastomózy. Včasná detekce lokálních ischemických změn by mohla predikovat komplikace, předejít rozvoji peritonitidy, snížit mortalitu a zvýšit šanci na záchranu funkční anastomózy. Mikrodialýza nabízí možnost kontinuální monitorace prostřednictvím hodnocení aktivity tkáňového metabolismu.

Hlavním cílem této práce bylo ověřit, zda mikrodialýza umožňuje monitoraci ischemických změn kolo-rektální anastomózy.

Metoda:
Do studie jsme zařadili 5 prasat s ručně šitou kolorektální anastomózou. Mikrodialyzační katétr byl zaveden intramurálně 5mm od okraje anastomózy. Tkáňové hladiny metabolitů byly sledovány každých 60 minut po dobu 6 hodin. Po třech měřeních byla provedena ischemizace anastomózy, po které následovaly další 3 hodiny monitorace.

Ke srovnání hodnot před a po ischemii byl použit Mann-Whitney test.

Výsledky:

Po ischemizaci anastomózy došlo k signifikantnímu poklesu tkáňové hladiny glukózy a pyruvátu. Naopak hladiny laktátu a glycerolu signifikantně vzrostly. Všechny detekované změny byly signifikantní již během prvních 60 minut po vyvolání ischemie.

Závěr:
Monitorace kolorektální anastomózy pomocí mikrodialýzy je technicky proveditelná a umožňuje včasné zachycení poruch perfuze.

Klíčová slova:
kolorektální anastomóza − dehiscence anastomózy − mikrodialýza


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