皮质类固醇对大白鼠小肠吻合口愈合的影响及维生素A的干预效应

Influence of corticosteroids on the healing of small intestinal anastomosis in rats with interfered effect of vitamin A

目的 :观察长期使用外源性超生理剂量皮质类固醇对大白鼠小肠吻合口愈合的影响及维生素 A的干预效应。方法 :给大白鼠使用皮质类固醇及维生素 A ,术后第 7天通过小肠吻合口爆破压、体视学、光镜、电镜及腹腔粘连 ,观察其对小肠吻合口愈合的影响。结果:(1)皮质类固醇组 :小肠爆破压下降 5 0 % ,中性白细胞及成纤维细胞数量明显减少 (P <0 .0 5 ) ,胶原沉积、新生的毛细血管减少 ,腹腔粘连减轻。(2 )皮质类固醇 +高剂量维生素 A组(术前或术后给药 ) :与皮质类固醇组相比 ,小肠爆破压明显升高 ,中性白细胞、成纤维细胞、胶原沉积、新生的毛细血管、腹腔粘连明显增加。(3)皮质类固醇 +低剂量维生素 A组 :与皮质类固醇组相比 ,小肠爆破压、中性白细胞、成纤维细胞、胶原沉积、新生的毛细血管、腹腔粘连均无明显增加。结论:(1)皮质类固醇可抑制炎性反应及细胞增殖分化 ,从而影响小肠吻合口愈合。 (2 )高剂量维生素 A(术前或术后给药 )可消除皮质类固醇对小肠吻合口愈合的延迟作用。(3)低剂量维生素 A对皮质类固醇造成的小肠吻合口愈合延迟无干预效应。(4 )对长期使用皮质类固醇 ,因故需行小肠吻合术的患者 ,围手术期使用维生素 A是有益的。

Objective: To observe the influence of over-physiological dose of corticosteroids on the healing of small intestinal anastomosis in rats with interfered effect of vitamin A. Methods: Corticosteroids and vitamin A were given to rats, on the postoperative day 7; the effect of them on the healing of small intestinal anastomosis was observed by bursting pressure of bowel, stereology, light microscope, electron microscope and abdominal adhesions. Results: (1) Corticosteroid group: Blurting pressure of bowel reduced 50%. The quantity of neutrophil and fibroblast remarkably decreased (P<0.05), collagen deposition, newly generated capillaries and abdominal adhesions were significantly reduced;(2) High-dose Vitamin A plus corticosteroid group (preoperatively or postoperatively): Bursting pressure, the quantity of neutrophil and fibroblast, collagen deposition, newly generated capillaries, and abdominal adhesions were remarkably increased; (3) Low-dose Vitamin A plus corticosteroid group: Bursting pressure, quantity of neutrophil and fibroblast not increased (P>0.05), collagen deposition, newly generated capillaries, and abdominal adhesions did not show significant difference as compared with corticosteroid group. Conclusions: (1) Corticosteroid can inhibit the healing of small intestinal anastomosis by interfering with normal inflammatory response and cell differentiation. (2) High-dose Vitamin A (perioperatively) may counteract the inhibitory effect of corticosteroid on small bowel anastomotic healing. (3) Low-dose Vitamin A has no such interfered effect. (4) It is suggested that patients receiving chronic corticosteroid therapy may receive Vitamin A perioperatively when undergoing intestinal operation.