Amniyon membranı yardımlı safra kanal anastomozu
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Karaciğer naklinin gerçekleştirilebilmesi ile birlikte siroz karaciğer yetmezliğinin ölümcül son evresi olmaktan çıkmıştır. Karaciğer nakil cerrahisi yaygınlaştıkça onunla ilgili çeşitli komplikasyonlar da gelişmiştir. Bunlardan en yaygın olarak görülenlerden biri de safra kanal anastomozuyla ilgili gelişen komplikasyonlardır. Bu komplikasyonlar hem ek morbiditeye sebep olmakta hem de hastanın hastanede yatış süresini uzatarak karaciğer nakli sonrası iyileşme ve rehabilitasyon sürecini sekteye uğratmaktadır. Çalışmamızın amacı karaciğer nakli başta olmakla safra kanal anastomozu gerektirecek birçok farklı klinik senaryoda kullanılabilecek basit bir cerrahi teknik ortaya koymaktır. Bu amaç doğrultusunda 30 adet Wistar-Albino cinsi sıçan kullanılarak bir deney tasarlandı. Bunlardan 8'i kontrol grubunda olarak sadece ortak safra kanalı diseksiyonu yapılarak kanal ortaya konmuş, sonrasında ek cerrahi girişim yapılmadan batın ve deri kapatılmıştır. 11 hayvan anastomoz grubuna alınarak ortak safra kanalı en geniş çaplı yerinden kesildikten sonra mikrocerrahi tekniğine uygun olarak uç-uca sütür ile anastomoz gerçekleştirilmiştir. 11 hayvan ise deney grubuna alınarak ortak safra kanalı kesildikten sonra uç-uca mikrocerrahi yöntemine uygun olarak sütür ile anastomoze edildikten sonra etrafına amniyon membranı sarılmıştır. Amniyon membranının anastomoz patensi üzerine etkilerini ortaya koymak amaçlı postop birinci haftada genel anestezi altında anastomoz distalinden kontrast madde verilerek radyolojik olarak anastomoz patensi gösterilmiş ve karaciğerdeki histolojik değişiklikleri göstermek amaçlı sıçan karaciğeri rezeke edilerek histolojik incelemeye verilmiştir. Sonuçta postop birinci haftada gerçekleştirilmiş olan eksplorasyon neticesinde makroskopik ve radyolojik olarak anastomoz ve deney grubu arasında fark saptanmamasına rağmen, mikroskopik olarak deney grubuna ait karaciğer materyallerindetotal Verhofstadt skorunda anlamlı derecede bir fark saptanmıştır. Buna göre amniyon sarılı safra anastomozu yapılan grubun karaciğer kesitlerinde doku enflamasyonu anlamlı derecede düşük bulunmuştur. Çalışmamız klinik olarak önemli sonuçları olmasına rağmen literatürde ihmal edilen bir alana ışık tutmaktadır. Deney modelimizin gelecekte bu alanda yapılacak olan çalışmalara öncülük etmesi ve literatürdeki boşluğu doldurarak klinik uygulamaların önünü açacağı düşünülmektedir. Anahtar sözcükler: Safra kanalları; Karaciğer nakli; Amniyon; Safra; Fibrozis
With the introduction of liver transplantation, cirrhosis is no longer the fatal end-stage of liver failure. As liver transplant surgery became widespread, various complications related to it has risen. Complications related to bile duct anastomosis are relatively common. These complications not only cause additional morbidity but also prolong the hospitalization period of the patient, hindering the recovery and rehabilitation process after liver transplantation. The aim of our study is to introduce a surgical technique that can be used in many different clinical scenarios requiring bile duct anastomosis including liver transplantation. For this purpose, an experiment was designed using 30 Wistar-Albino rats. Eight of them were in the sham operation control group, in which only the common bile duct dissection and exposition were done without any additional surgical intervention. 11 animals were included in the anastomosis (control) group; in which after the common bile duct was cut at its widest point, anastomosis was performed with an end-to-end microsurgery anastomosis technique with nylon sutures. 11 animals were included in the experimental group; in which after the common bile duct was cut, an end-to-end anastomosis was made with microsurgical anastomosis and amniotic membrane wrapped around. To reveal the effects of the amniotic membrane on anastomosis patency, it was demonstrated radiologically by administering contrast material from the distal to the anastomosis under general anesthesia at the postoperative first week and animals' livers were removed to show the histological findings. As a result, although there was no difference between the anastomosis and the experimental group macroscopically and radiologically at the exploration performed at the postoperative first week, a significant difference was found in the total Verhofstadt score in the liver materials of the experimental group microscopically. Although there are many clinical implications, this topic could not get enough amount of attention from researchers. Our study sheds light on a neglected area in literature. We think, in the future our experimental model will guide the studies to be done in this field and will contribute to the literature which could lead to clinical applications. Keywords: Bile ducts; Liver Transplantations; Amnion; Bile; Fibrosis
With the introduction of liver transplantation, cirrhosis is no longer the fatal end-stage of liver failure. As liver transplant surgery became widespread, various complications related to it has risen. Complications related to bile duct anastomosis are relatively common. These complications not only cause additional morbidity but also prolong the hospitalization period of the patient, hindering the recovery and rehabilitation process after liver transplantation. The aim of our study is to introduce a surgical technique that can be used in many different clinical scenarios requiring bile duct anastomosis including liver transplantation. For this purpose, an experiment was designed using 30 Wistar-Albino rats. Eight of them were in the sham operation control group, in which only the common bile duct dissection and exposition were done without any additional surgical intervention. 11 animals were included in the anastomosis (control) group; in which after the common bile duct was cut at its widest point, anastomosis was performed with an end-to-end microsurgery anastomosis technique with nylon sutures. 11 animals were included in the experimental group; in which after the common bile duct was cut, an end-to-end anastomosis was made with microsurgical anastomosis and amniotic membrane wrapped around. To reveal the effects of the amniotic membrane on anastomosis patency, it was demonstrated radiologically by administering contrast material from the distal to the anastomosis under general anesthesia at the postoperative first week and animals' livers were removed to show the histological findings. As a result, although there was no difference between the anastomosis and the experimental group macroscopically and radiologically at the exploration performed at the postoperative first week, a significant difference was found in the total Verhofstadt score in the liver materials of the experimental group microscopically. Although there are many clinical implications, this topic could not get enough amount of attention from researchers. Our study sheds light on a neglected area in literature. We think, in the future our experimental model will guide the studies to be done in this field and will contribute to the literature which could lead to clinical applications. Keywords: Bile ducts; Liver Transplantations; Amnion; Bile; Fibrosis
Açıklama
Anahtar Kelimeler
Plastik ve Rekonstrüktif Cerrahi, Plastic and Reconstructive Surgery, Bile ducts, Liver Transplantations, Amnion, Bile, Fibrosis
