Ratlarda Mastektomi ve Aksiller Disseksiyon Sonrası Mikro Gözenekli Polisakkarit Kürecikler (Arista Kullanımının Seroma Oluşumuna Etkisi

Başlık: Ratlarda Mastektomi ve Aksiller Disseksiyon Sonrası Mikro Gözenekli Polisakkarit Kürecikler (Arista Kullanımının Seroma Oluşumuna Etkisi
Yazar: Tufan Egeli
Yazar-email: tufanegeli@gmail.com
Kurum: Dokuz Eylül Üniversitesi Tıp Fakültesi Genel Cerrahi A.D.
Yil: 2009
Anahtar: Seroma, mastektomi, arista, yara iyileşmesi,cerrahi alan, infeksiyonları risk faktörleri
Ozet: Amaç: Seroma, meme kanseri cerrahisi sonrası en sık görülen komplikasyondur (%10-50)(1,2,3,4). Doku diseksiyonu ya da doku eksizyonu ile oluşan ölü boşluğa lenfovasküler sıvı kaçağı sonucu ortaya çıkar. Güncel çalışmalara göre, uzamış enflamatuar yanıt veya yara iyileşmesinin ilk fazının uzaması sonucu gelişen anormal eksuda vasıflı sıvı lokülasyonu seroma oluşumunda en önemli etkendir (1,5,6,7). Seroma, yara yeri enfeksiyonu, abse, doku nekrozu ve sepsis gibi ciddi komplikasyonlara sebep olabilmektedir. Mikro gözenekli polisakkarit kürecikler (MPK (Arista®)), matris jel oluşturma etkisiyle, bağlama, kompres ya da diğer yöntemlerle durdurulması zor olan kanamalarda hemostaz sağlamak amacıyla kullanılmaktadır. Bu çalışmada amaç, MPK\\’nın lenfovasküler sızıntıyı engelleyerek ve polisakkarit yapısı sayesinde yara iyileşmesini hızlandırarak seroma oluşumunu azaltabileceğini ortaya koymaktır.
Gereç ve Yöntem: Çalışmada, ortalama 200-250 gr. ağırlığında genç, dişi Wistar ratlar kullanıldı. Kontrol ve çalışma grupları sekizer rattan oluşturuldu. Ratlara sağ mastektomi ve aksilla dissekisyonu uygulandı. Ameliyat sonrası kontrol grubuna herhangi bir uygulama yapılmazken, çalışma grubuna ameliyat sonrası lokal MPK uygulandı. Operasyondan 10 gün sonra mastektomi kavitesinden steril enjektör ile seromalar aspire edildi, miktarları ölçüldü ve laboratuvar parametreleri (total protein,albumin, Laktat dehidrogenaz (LDH),total kan hücre sayımı,C reaktif protein (CRP)) incelendi. Ratlar anestezi altında sakrifiye edilerek operasyon lojundan doku örnekleri alındı, patolojik değerlendirmeleri yapıldı. Örnekler, damar proliferasyonu, fibrin miktarı, ödem, nekroz, konjesyon, mikroorganizma, polimorfonükleer lökosit, fibroblast ,lenfosit, makrofaj ve fibröz doku artışı açısından
değerlendirildi.
Bulgular: Değerlendirmeler sonunda, çalışma grubunda seroma, kontrol grubuna göre anlamlı olarak daha az meydana geldi (p= 0,001). Çalışma grubundan elde edilen aspiratlarda, eksuda mayiinin önde gelen bileşenlerinden albumin ve LDH anlamlı olarak daha az miktarlarda saptandı (p<0,003). Total protein miktarı da yine çalışma grubunda daha düşük seviyelerde ölçüldü. Patolojik incelemelerde de fibröz doku artışı kontrol grubunda, çalışma grubuna oranla anlamlı ölçüde daha çok izlendi (p= 0,032). Ayrıca, makrofaj gibi yara iyileşmesinin enflamatuar fazında daha yoğun olarak görülen hücreler, kontrol grubunda, çalışma grubuna göre daha yoğun olarak gözlendi.
Sonuç: Bu çalışmada, MPK\\’nın matris jel oluşturma etkisiyle, mastektomi ve aksiller diseksiyon sonrası ortaya çıkan lenfatik ve vasküler sızıntıları engellediği, bunun yanı sıra polisakkarit yapıda olması nedeniyle yara iyileşme sürecini de hızlandırarak seroma oluşumunu azalttığı sonucuna
varılmıştır.
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