|Budget Amount *help
¥1,800,000 (Direct Cost : ¥1,800,000)
Fiscal Year 1999 : ¥500,000 (Direct Cost : ¥500,000)
Fiscal Year 1998 : ¥1,300,000 (Direct Cost : ¥1,300,000)
1. Basic Study : Experimental animals were devided into Lipopolysaccharide (LPS) and control groups, which had either LPS or normal saline solution into the peritoneal cavity 24 hours before transaction and anastomosis of the colon. Anastomotic bursting pressure (ABP) and tissue hydroxyproline concentration (HP) were then measured as indicators for wound healing. Immunohistochemical staining for TNF-α and IL6 was performed on tissue samples obtained from the anastomotic segment, lung, liver and kidney. The reactive cells were counted under a light microscope ABP and HP were significantly lower in the LPS group than in the control group 7 days after surgery. In the LPS group, INF- α and IL-6 expressions around the anastomotic segment were enhanced 1 hour and 6 hours after surgery, but IL-6 expression was suppressed 24 hours after surgery. On the other hand, cytokine expression in the lung, liver and kidney was enhanced in the LPS group 24 hours after the surgery, but not in the control group.
2. Clinical Study : Tissue samples were obtained from the liver of patients performed digestive surgery on time of laparotomy and closing. Immunohistochemical staining for TNF-α and IL-6 was performed, then the reactive cells were counted under a light microscope. Significant correlations were found between the numbers of reactive cells for TNF-α or IL-6 and postoperative levels of ALT, AST and CRP. On the other hand, in patients treated with steroid preoperatively, cytokine expression on the liver was significantly suppressed than in patients without steroid.
3. Conclusion : An inflammatory reaction, which is necessary for successful wound healing, was suppressed locally under severe stress. However, on the other hand, an inflammatory reaction mediated by cytokines, which may induce multiple organn dysfunction, occurred in important organs. These results the process of multiple organ dysfunction followed by postoperative complications, including leakage of intestinal anastomosis.