Celecoxib’in mastektomi sonrasında gelisen seroma ve yara iyilesmesine etkisinin incelenmesi

Başlık: Celecoxib’in mastektomi sonrasında gelisen seroma ve yara iyilesmesine etkisinin incelenmesi
Yazar: Evren Besler
Yazar-email: evrenbesler@hotmail.com
Kurum: D.E.Ü.T.F. Genel Cerrahi Anabilim Dalı
Yil: 2007
Anahtar: Seroma, mastektomi , celecoxib, yara iyileşmesi, inflamasyon
Ozet: Seroma meme kanser cerrahisi sonrasında ortaya çıkan ölü boslukta seröz
sıvı birikimidir. Seromanın patofizyolojisi net olarak aydınlatılamamıstır. Seroma
gelisimi hastanede kalıs süresinin uzaması, maliyet artısı, fleplerde iskemi, sıvı
birikimine baglı infeksiyon ve adjuvan tedavide gecikmeye yol açmaktadır. Seroma
günümüzde halen güncel bir sorundur; ve bu sorun için en çok uygulanan yöntem
ameliyat sonrası bes – yedi gün süre ile drenaj ve tekrarlanan aspirasyonlardan
ibarettir.
Bu çalısmada antiinflamatuar, antianjiyogenik ve antioksidan etkinligi
gösterilmis olan celecoxib’in disi Wistar ratlar üzerinde uygulanan mastektomi
modelinde seroma’ya etkinligi incelendi. Kontrol grubunda 10, celecoxib grubunda
10 olmak üzere toplam 20 rat incelemeye alındı. Mastektomi sonrasında celecoxib
grubuna intraperitoneal 0.25 cc/250gr (20 mg/kg/gün) bes gün süre ile, kontrol
grubuna ise aynı volümde serum fizyolojik bes gün süre ile verildi. Tüm ratların
agırlıkları ameliyat öncesi ölçüldü. Ratlar ameliyat sonrasında 10 gün izlendi. Bu
süreç içinde ratların canlılıkları, kol hareketleri, yara yeri iyilesme durumları, yara
infeksiyonu, flep nekrozu ve seroma olusumları kaydedildi. Bu süre sonunda
seromalar aspire edildi ve doku örnekleri alınarak ratlar sakrifiye edildi. Doku
örneklerinde fibrin, kanama, ödem, damarlanma, konjesyon, PMNL (polimorf nüveli
lökositler), fibröz doku artısı, fibroblast, lenfosit ve makrofajlar degerlendirildi. Seroma
sıvılarında ise inflamasyon parametrelerinden akut faz reaktanı olan IL-1ß (_nterlökin
1 beta) ve damar proliferasyonu ve anjiyogenezin temel parametresi olan VEGF
(vasküler endotelyal büyüme faktörü) incelemesi yapıldı.
Deneyler sonunda biyokimyasal incelemede celecoxib uygulanan grupta
seroma volümlerinin belirgin olarak azaldıgı (p=0,00 ;U=0,00), seroma sıvısında IL-
1ß düzeyinin belirgin olarak azaldıgı (U=15,0; p=0,014), histopatolojik incelemede ise
celecoxib grubunda konjesyonun arttıgı (x²=0,044) tesbit edildi. Ameliyat sonrası
celecoxib grubunda bir ratta infeksiyon ve yara ayrılması, kontrol grubunda ise bir
ratta histopatolojik olarak mikroorganizma görüldü. Bu iki rat çalısma dısına çıkarıldı.
Bu çalısmanın sonucunda, celecoxib’in mastektomi sonrası seroma volümlerini
belirgin olarak azalttıgı, bir akut faz reaktanı olan IL-1ß’yı baskıladıgı; bu etkisinin
antiinflamatuar etkisi ile oldugu sonucuna varıldı. Celecoxib’in etkilerinin farklı doz
uygulamalarıyla ve daha genis sayıda denek üzerinde arastırılması gerektigi
düsünüldü.
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