دورية أكاديمية
Effect of Surgical Technique on the Microstructure and Microcirculation of the Small Intestine Stump during Delayed Anastomosis: Multimodal OCT Data.
| العنوان: | Effect of Surgical Technique on the Microstructure and Microcirculation of the Small Intestine Stump during Delayed Anastomosis: Multimodal OCT Data. |
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| المؤلفون: | Kiseleva EB; Senior Researcher, Scientific Laboratory of Optical Coherence Tomography, Research Institute of Experimental Oncology and Biomedical Technologies; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia., Ryabkov MG; Associate Professor, Leading Researcher, University Clinic; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia., Sizov MA; Surgeon; City Clinical Hospital No.30, 85A Berezovskaya St., Nizhny Novgorod, 603157, Russia., Bederina EL; Pathologist, Junior Researcher, University Clinic; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia., Komarova AD; Student, Department of Biophysics; National Research Lobachevsky State University of Nizhni Novgorod, 23 Prospekt Gagarina, Nizhny Novgorod, 603950, Russia; Laboratory Assistant, Laboratory of Fluorescent Bioimaging, Research Institute of Experimental Oncology and Biomedical Technologies; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia., Moiseev AA; Senior Researcher, Laboratory of Highly Sensitive Optical Measurements; Federal Research Center Institute of Applied Physics of the Russian Academy of Sciences, 46 Ulyanova St., Nizhny Novgorod, 603950, Russia., Bagryantsev MV; Surgeon; City Clinical Hospital No.30, 85A Berezovskaya St., Nizhny Novgorod, 603157, Russia., Vorobiev AN; Surgeon; City Clinical Hospital No.30, 85A Berezovskaya St., Nizhny Novgorod, 603157, Russia., Gladkova ND; Professor, Head of the Scientific Laboratory of Optical Coherence Tomography, Research Institute of Experimental Oncology and Biomedical Technologies; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia. |
| المصدر: | Sovremennye tekhnologii v meditsine [Sovrem Tekhnologii Med] 2021; Vol. 13 (4), pp. 36-45. Date of Electronic Publication: 2021 Aug 28. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Nizhegorodskai︠a︡ gosudarstvennai︠a︡ medit︠s︡inskai︠a︡ akademii︠a Country of Publication: Russia (Federation) NLM ID: 101604515 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2309-995X (Electronic) Linking ISSN: 20764243 NLM ISO Abbreviation: Sovrem Tekhnologii Med Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Nizhniĭ Novgorod : Nizhegorodskai︠a︡ gosudarstvennai︠a︡ medit︠s︡inskai︠a︡ akademii︠a︡ |
| مواضيع طبية MeSH: | Intestine, Small*/diagnostic imaging , Mesenteric Ischemia*/surgery, Anastomosis, Surgical ; Animals ; Male ; Microcirculation ; Rats ; Rats, Wistar |
| مستخلص: | The aim of the study was to use multimodal optical coherence tomography (MM OCT) to evaluate microstructure and microcirculation in the proximal and distal sections of the intestine relative to the resected area in acute mesenteric ischemia. Materials and Methods: The study was carried out using three groups of male Wistar rats weighing 270-435 g (n=18). Acute occlusive arterial ischemia of the small intestine was initiated in all animals. After 80-90 min, the ischemic non-viable part of the intestine was resected, and the operation was completed by stoma exteriorization (group 1, n=6), by applying purse-string sutures (group 2, obstructive resection, n=6), or by internal drainage of the proximal and distal ends of the small intestine (group 3, bypass, n=6). Relaparotomy and anastomosis formation were performed 2 days later.With the help of MM OCT at each stage of the surgical intervention, images were obtained from the serous membrane side: the intestinal wall microstructure (layers) was viewed using cross-polarization OCT (CP OCT) and the intramural circulation - using optical coherent angiography (OCA). The MM OCT images obtained from the terminal intestine sections immediately after resection and 2 days later (before the anastomosis formation) were compared between the experimental groups, as well as with the pre-ischemic data (norm). All resected sections of the intestine were then histologically examined. The MM OCT data were compared with the histological and intravital macroscopy data. Results: As a result of studying the intestinal wall microstructure by in vivo CP OCT, it was found that during ostomy (group 1) and obstructive resection (group 2), the images showed signs of tissue edema and destructive changes in the mucous membrane that were confirmed histologically, while with bypass surgery (group 3), there were minimal changes as compared with the norm.According to the OCA data, on day 2 of ostomy in the proximal and distal segments of the intestine, there was a noticeable disappearance of small and medium blood vessels; mainly large arteries and veins could be visualized. Following obstructive resection (purse-string suturing) or bypass surgery, the most noticeable changes (a decrease in the number of visualized blood vessels) were observed in the distal part of the intestine. The L index calculated from OCA images and characterizing the total length of the intramural perfused vasculature, showed a statistically significant decrease during ostomy: 12.18 [10.40; 14.20] μm - in the proximal and 10.67 [7.98; 13.05] μm - in the distal section; for comparison, the L index before ischemia was 18.90 [17.98; 19.73] μm and 18.74 [17.46; 19.90] μm, respectively (p=0.0001). In obstructive resection (group 2), statistically significant differences in the L parameter were found only for the distal bowel section: 16.39 [12.37; 18.10] μm compared with 18.74 [17.46; 19.90] μm before ischemia (p=0.041). After bypass surgery (group 3), there were no significant deviations in the L index. Conclusion: By using MM OCT, we found that in treating the remaining sections of the intestine after its emergency resection for acute mesenteric ischemia, the type of surgical technique determines the tissue structure in the period before the delayed anastomosis is applied.The least pronounced and most balanced changes occur in the proximal and distal segments of the intestine when operated using the bypass technique. However, to recommend this type of surgery, the development of reliable, safe, and effective bypass instruments is needed. Competing Interests: Conflicts of interest. The authors have no conflicts of interest. |
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| فهرسة مساهمة: | Keywords: CP OCT*; MM OCT*; OCA*; acute intestinal ischemia*; cross-polarization optical coherence tomography*; enteroanastomosis*; enterostomy*; intestinal viability*; multimodal optical coherence tomography*; optical coherence angiography* |
| تواريخ الأحداث: | Date Created: 20211004 Date Completed: 20220329 Latest Revision: 20220427 |
| رمز التحديث: | 20231215 |
| مُعرف محوري في PubMed: | PMC8482830 |
| DOI: | 10.17691/stm2021.13.4.04 |
| PMID: | 34603762 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2309-995X |
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| DOI: | 10.17691/stm2021.13.4.04 |