局部缓释血管内皮生长因子促进肠吻合口愈合的研究

Study of Accelerating Effect of Local Delayed Releasing Vascular Endothelial Growth Factor on Healing of Intestinal Anastomotic Stoma

目的探讨应用生物蛋白胶缓释血管内皮生长因子(VEGF)促进肠吻合口愈合的有效性。方法通过在兔盲肠穿孔建立腹腔感染的动物模型,12h后行肠切除及肠吻合。动物分成4组(每组32只),各组吻合口表面所涂试剂不同:生理盐水组、生物蛋白胶组、VEGF组及VEGF+生物蛋白胶组。于手术后第3、5、7及14天统计各组吻合口漏发生情况,测量未发生吻合口漏的动物的吻合口破裂压,检测吻合口组织羟脯氨酸含量及VEGF表达情况。结果生物蛋白胶组及VEGF组的吻合口漏总发生率低于对照组,但差异无统计学意义(P>0.05),而VEGF+生物蛋白胶组则明显低于对照组(P<0.05)。至术后第14天,VEGF+生物蛋白胶组的吻合口破裂压、吻合口组织羟脯氨酸含量及VEGF蛋白表达阳性细胞率(除VEGF组)均较其余3组明显升高(P<0.05,P<0.01)。结论应用生物蛋白胶局部缓释VEGF能够促进肠吻合口愈合,降低吻合口漏的发生率。

Objective To investigate the effect of local delayed releasing vascular endothelial growth factor（VEGF）on accelerating healing of intestinal anastomotic stoma.Methods An intra-abdominal infection modal of rabbit was established by artificial appendix perforation,and excision and anastomosis of terminal ileum were subsequently performed after 12h.The animals were divided into four groups（32for each group）with different reagents on anastomotic surface：control group,fibrin glue group（FG group）,VEGF group,and VEGF＋FG group.The incidence of stomal leak,anastomosic bursting pressure,hydroxyproline content,and expression of VEGF in cured stoma tissue were measured respectively on day 3,5,7and 14after operation.Results The total incidence rate of leakage was lower in FG group and VEGF group than that in control group,but there was no statistical significance（P0.05）.The incidence rate was significantly lower in FG＋VEGF group than that in control group（P0.05）.On day 14postoperatively,the bursting pressure of anastomotic stoma,hydroxyproline content,and positive cell expression rate of VEGF protein（except VEGF group）were significantly increased in FG ＋VEGF group than those in other three groups（P0.05,P0.01）.Conclusion Local delayed release of VEGF by fibrin glue can improve the healing of intestinal anastomotic stoma and reduce the incidence of stomal leak.