Морфологічні зміни в передній черевній стінці щурів при виконанні повздовжніх та поперечних доступів при резекції товстої кишки в умовах стресу при застосуванні програми «Fast track surgery»

Abstract

При морфологічному дослідженні ділянок передньої черевної стінки щурів в серії експериментальних досліджень було встановлено що застосування поперечної лапаротомія для резекції товстої кишки у тварин, які перебували в умовах тривалого стресу було більш оптимальним у порівнянні з позвдовжньою лапаротомією. Було встановлено покращення морфологічного стану післяопераційного рубця. Ознаками в пізні терміни є наявність сформованого рубця у вигляді зрілої фіброзної тканини, реорганізація волокон посмугованої м’язової тканини та судин артеріального та венозного типів.

При морфологическом исследовании участков передней брюшной стенки крыс в серии экспериментальных исследований было установлено, что применение поперечной лапаротомия для резекции толстой кишки у животных, находившихся в условиях длительного стресса было более оптимальным по сравнению с продольной лапаротомией. Было установлено улучшение морфологического состояния послеоперационного рубца. Признаками в поздние сроки являлись наличие сформированного рубца в виде зрелой фиброзной ткани, реорганизация волокон исполосованной мышечной ткани и сосудов артериального и венозного типов.

The experiment was performed on 42 white laboratory sexually mature non-linear male rats at the premises of the scientific and experimental clinic of Vinnytsia National Pirogov Memorial Medical University. In the first group of animals lower midline laparotomy was performed and in the second group - lower transverse laparotomy. The large bowel resection was also performed in both groups of animals later. After the surgical intervention, all animals were exposed to chronic stress. The animals of both groups were withdrawn from the experiment on the 3, 14, 30 day of the experiment. On the third day of examination a significant swelling of papillary and reticular dermis with local lymphostasis was detected in the group of animals, which underwent longitudinal laparotomy, large bowel resection and were exposed to stress. The expressed diffuse lymphohistiocytic infiltration of dermis and striated muscle tissue was detected. Focal angiogenesis was detected. In 14 days, focal infiltration of the dermis and striated muscle tissue with segmented leukocytes was observed. The expressed swelling and thickening of collagen fiber bundles, their disorganization with the formation of coarse unshaped connective tissue were determined. Fibers of striated muscle tissue were fragmented. On the 30th day, mild swelling of papillary and reticular dermis was observed. In dermis and striated muscle tissue, a slight diffuse lymphohistiocytic infiltration was detected. Mild swelling of bundles of collagen and elastic fibers and focal cicatricial fibromatosis were found. In the group of animals, which underwent transverse laparotomy, large bowel resection and were exposed to stress, a significant swelling of the papillary and reticular dermis was observed on the third day. Mild diffuse infiltration of dermis and striated muscle tissue with segmented leukocytes was observed. Lymphohistiocytic infiltration of striated muscle tissue was detected in muscle tissue. In the group of animals, which underwent transverse laparotomy on the 14th day of examination, the swelling of papillary and reticular dermis was mild and less than in animals with longitudinal access. Slight diffuse infiltration with blood elements was observed in dermis. Vessels of the microcirculatory bed were partially rebuilt. In the group of animals, which underwent transverse laparotomy on the 30th day of examination, slight swelling of papillary and reticular dermis was observed. In the experimental group, a formed scar, represented by mature fibrous tissue basically by oriented bundles of collagen and elastic fibers and a significant number of vessels of the microcirculatory bed was detected. Diffuse fibrosis was found in striated muscle tissue. Also, the reorganization of fibers of striated muscle tissue and vessels of arterial and venous types was observed. Therefore, during the morphological examination of the parts of the anterior abdominal wall of rats in a series of experimental studies, it was found that the use of transverse laparotomy for large bowel resection in animals, that were exposed to stress, was more efficient in comparison with longitudinal laparotomy. The morphological condition of the postoperative scar improves. The distinctive features are the presence of a formed scar, represented by mature fibrous tissue, and the reorganization of fibers of striated muscle tissue and vessels of arterial and venous types. Therefore, in the context of use of the multimodal program «Fast track surgery», we recommend transverse laparotomy.