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DOI: 10.1055/s-2000-12049
Anastomosenheilung
Anastomotic HealingPublication History
Publication Date:
31 December 2000 (online)
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Zusammenfassung.
Die Anastomosenheilung nimmt einen regelhaften Verlauf. Ähnlich wie die Wundheilung grundsätzlich, verläuft sie morphologisch in drei sich teilweise überlappenden Phasen. Dabei ist die Anastomosenheilung aber im Vergleich zur allgemeinen Wundheilung beschleunigt. Die exsudative Phase ist geprägt durch ein Ödem und die Exsudation von Fibrin und Blutbestandteilen mit Einwanderung von Entzündungszellen, v. a. Makrophagen, sowie Fibrinstabilisierung. Die proliferative Phase zeichnet sich durch die Bindegewebseinsprossung sowie Kollagenbildung aus. Die reparative Phase ist durch die Stabilisierung des Kollagens mit Reorganisation der Darmwandschichten charakterisiert. Letztlich verbleibt immer eine Defektheilung mit unterschiedlicher Narbenbildung. Aus chirurgischer Sicht besonders relevant sind vor allem die ersten beiden Wundheilungsphasen wegen des hier zunächst eintretenden Stabilitätsverlustes bis zum 3.-4. postoperativen Tag und der dennoch einsetzenden sehr schnellen Festigkeitszunahme.
Anastomotic Healing.
Anastomotic healing takes a regular course. As in common wound healing this process can be divided into three partially overlapping phases. Anastomotic healing, however, is faster than regular wound healing of the skin. The exsudative phase is characterized by an edema and the exsudation of fibrin and blood components. Furthermore, sequestration of inflammatory cells, such as macrophages and stabilization of the fibrin clot can be observed. The proliferative phase consists of growing soft tissue as well as collagen deposits within the tissue. The reparative phase, finally, is characterized by stabilization of the collagen. Nonetheless, anastomotic healing is a defect healing with varying grades of scar formation. From the surgeonŽs point of view, the first two phases of wound healing are of special interests since during the first three to four days after surgery a profound loss of stability can be observed, which is followed by a very fast increase of stability.
Schlüsselwörter:
Anastomosen - Anastomosenheilung - Phasen der Wundheilung - Gastrointestinaltrakt
Key words:
Anastomoses - Anastomotic healing - Phases of healing - Gastrointestinal tract
Literatur
- 1 Langer S. Colon-Nahttechnik: einreihige Naht. Langenbecks Arch Chir. 1978; 347 601-604
- 2 Jacobs G, Ulrich B. Klammernahtgeräte am Magen und Dünndarm. Langenbecks Arch Chir. 1981; 355 465-469
- 3 Ellison G W. Wound healing in the gastrointestinal tract. Semin Vet Med Surg. 1989; 4 287-293
- 4 Halsted W S. Circular suture of the intestine - an experimental study. Am J Med Sci. 1887; 94 436-461
-
5 Junginger T h, Pichlmaier H.
Nahtmaterialien und Nahttechniken in der Kolonchirurgie. In: Thiede A, Hamelmann H (Hrsg) Moderne Nahtmaterialien und Nahttechniken in der Chirurgie. Springer Berlin Heidelberg New York; 1982: 288-295 - 6 Brasken P, Lehto M, Renvall S. Fibronectin, laminin, and collagen types I, III, IV and V in the healing rat colon anastomosis. Ann Chir Gynaecol. 1990; 79 65-71
- 7 Grinnel F, Billingh R, Burgess L. Distribution of fibronectin during wound healing in vivo. J Invest Dermatol. 1981; 76 181-189
- 8 Lehto M, Duance V C, Restall D. Collagen and fibronectin in a healing skeletal muscle injury. J Bone Joint Surg (Brit). 1985; 67 820-828
-
9 Leder L D.
Wundheilung und Fremdkörperreaktion. In: Thiede A, Hamelmann H (Hrsg) Moderne Nahtmaterialien und Nahttechniken in der Chirurgie. Springer Berlin, Heidelberg, New York; 1982: 226-228 -
10 Kerscher P, Wünsch H P, Lehmann L, Eich J.
Ist die alleinige Naht der Submukosa eine Alternative zu den bisherigen Nahttechniken? . In: Thiede A, Hamelmann H (Hrsg) Moderne Nahtmaterialien und Nahttechniken in der Chirurgie. Springer Berlin, Heidelberg, New York; 1982: 135-144 - 11 Gabella G. The cross-ply arrangement of collagen fibres in the submucosa of the mammalian small intestine. Cell Tissue Res. 1987; 248 491-497
- 12 Epstein E H, Munderloh N H. Isolation and characterization of CNBr peptides of human [1(III)]3 collagen and tissue distribution of [1(I)]2 2 and [1(III)]3 collagens. J Biol Chem. 1975; 25 9304-9312
- 13 Klein L R, Chandra Rajan J. Collagen degradation in rat skin but not in intestine during rapid growth: effect on collagen types I and III from skin. Proc Natl Acad Sci USA. 1977; 74 1436-1439
- 14 Kerscher P, Wünsch H, Steidl H. Naht der Submucosa bei der Dickdarmanastomose. Chirurg. 1979; 5 770-774
- 15 Lord M G, Valies P, Broughton A C. A morphologic study of the submucosa of the large intestine. Surg Gynecol Obstet. 1977; 145 55-60
- 16 Spjut H J. Microangiographic study of gastrointestinal lesions. Am J Roentgenol. 1974; 92 1173-1187
- 17 Abramowitz H B, McAlister W H. A comparative study of small-bowel anastomoses by angiography and microangiography. Surgery. 1969; 66 564-569
- 18 Stelzner F. Vorbeugung der intraperitonealen Nahtinsuffizienz (Dünn- und Dickdarm). Langenbecks Arch Chir. 1982; 358 259-263
- 19 Martens M FWC, Hendriks T. Postoperative changes in collagen synthesis in intestinal anastomoses of the rat: differences between small and large bowel. Gut. 1991; 32 1482-1487
- 20 Wise L, McAlister W, Stein T h, Schuck P. Studies on the healing of anastomoses of small and large intestines. Surg Gynecol Obstet. 1975; 141 190-194
- 21 Nahai F, Lamb J M, Havican R G, Stone H H. Factors involved in disruption of intestinal anastomoses. Am Surg. 1977; 43 45-51
- 22 Martens M FWC, Hendriks T. Collagen synthesis in explants from rat intestine. Biochim Biophys Acta. 1989; 993 252-258
-
23 Cohn I, Nance F C.
Physiology . In: Sabiston DC (ed.) Textbook of Surgery. 12th Ed., Saunders Philadelphia; 1981: 1069-1070 - 24 Cronin K, Jackson D S, Dunphy J E. Changing bursting strength and collagen content of the healing colon. Surg Gynecol Obstet. 1968; 126 747-753
- 25 Hofstädter F. Pathologie der Wundheilung. Chirurg. 1995; 66 174-181
- 26 Jiborn H, Ahonen J, Zederfeldt B. Healing of experimental colonic anastomoses. II. Breaking strength of the colon after left colon resection and anastomosis. Am J Surg. 1978; 136 595-599
- 27 Hastings J C, van Winkle W, Barker E, Hines D, Nichols W. Effect of suture materials on healing wounds of the stomach and the colon. Surg Gynecol Obstet. 1975; 14 701-707
- 28 Ross R, Lillywhite J W. The fate of buffy coat cells grown in subcutaneous implanted diffusion chambers. A light and electron microscopic study. Lab Invest. 1965; 14 1568-1585
- 29 Carrel A. The treatment of wounds. JAMA. 1910; 25 2148-2150
- 30 Hendriks T, Mastboom W JB. Healing of experimental intestinal anastomoses: parameters for repair. Dis Colon Rectum. 1990; 33 891-901
- 31 Howes E L, Sooy J W, Harvey S C. The healing of wounds as determined by their tensile strength. JAMA. 1929; 92 42-45
- 32 Peacock E E, van Winkle W. Wound repair. 2nd Edition, Saunders Philadelphia; 1976
- 33 Chlumsky V. Experimentelle Untersuchungen über die verschiedenen Methoden der Darmvereinigung. Bruns Beitr Klin Chir. 1899; 25 539-600
- 34 Hernandez-Richter H J, Struck H. Die Wundheilung. Theoretische und praktische Grundlagen. Thieme Stuttgart; 1970
- 35 Langer S, Kupczyk D. Entstehung der Nahtinsuffizienz (Kongressbericht 1982). Langenbecks Arch Chir. 1982; 358 253-258
- 36 Lindner J. Morphologie und Biochemie der Wundheilung. (Kongressbericht 1982). Langenbecks Arch Chir. 1982; 358 153-160
- 37 Nockemann P F. Die chirurgische Naht. 3. Auflage, Thieme Stuttgart, New York; 1980
- 38 Kozol R A, Mulligan M, Downes R J, Forouhar F A, Kreutzer D L. Early colonic anastomotic edema. Evaluation of stapled vs hand-sewn anastomoses. Dis Colon Rectum. 1988; 31 503-506
- 39 Hesp W LEM, Hendriks T, Schillings P HM, Lubbers E JC, De Boer H HM. Histological features of wound repair: a comparison between experimental ileal and colonic anastomoses. Br J Exp Path. 1985; 66 511-518
- 40 Irvin T T. Wound healing. Principle and Practice. Chapman and Hall London; 1981
- 41 Diegelmann R F, Cohen I K, Kaplan A H. The role of macrophages in wound repair: A review. Plast Reconstr Surg. 1981; 68 107-113
- 42 Assoian R K, Fleurdelys B E, Stevenson H C, Miller P J, Madtes D K, Raines E W, Ross R, Sporn M B. Expression and secretion of type-b transforming growth factor by activated human macrophages. Proc Natl Acad Sci. 1987; 84 6020-6024
- 43 Austgulen R, Hammerstom J, Nissen-Meyer J. In vitro cultured human monocytes release fibroblast proliferation factor(s) different from interleukin 1. J Leukoc Biol. 1987; 42 1-8
- 44 Bitterman P B, Rennard S I, Hunninghake G W, Crystal R G. Human alveolar macrophage growth factor for fibroblasts: Regulation and partial characterization. J Clin Invest. 1982; 7 806-822
- 45 Calderon J, Williams R T, Unanue E R. An inhibitor of cell proliferation released by cultures of macrophages. Proc Natl Acad Sci. 1974; 71 4273-4277
- 46 Jordana M, Newhouse M T, Gauldie J. Alveolar macrophage/peripheral blood monocyte-derived factors modulate proliferation of primary lines of human lung fibroblasts. J Leukoc Biol. 1987; 42 51-60
- 47 Leibovich S J, Ross R. A macrophage-dependent factor that stimulates the proliferation of fibroblasts in vitro. Am J Pathol. 1976; 84 501-513
- 48 Martin B M, Gimbrone jr M A, Unanue E R, Cotran R S. Stimulation of nonlymphoid mesenchymal cell proliferation by a macrophage derived growth factor. J Immunol. 1981; 126 1510-1515
- 49 Metzger Z, Hoffeld J T, Oppenheim J J. Suppression of fibroblast proliferation by activated macrophages: Involvement of H2O2 and a non-prostaglandin E product of the cyclooxygenase pathway. Cell Immunol. 1986; 1 501-514
- 50 Phan S M, McGarry B M, Loeffler K M, Kunkel S L. Regulation of macrophage-derived fibroblast growth factor release by arachidonate metabolites. J Leukoc Biol. 1987; 42 106-113
- 51 Sugarman B J, Lewis G D, Eessalu T E, Aggarwal B B, Shepard H M. Effects of growth factors on the antiproliferative activity of tumor necrosis factors. Cancer Res. 1987; 47 780-786
- 52 Wharton W, Gillespie G Y, Russel S W, Pledger W J. Mitogenic activity elaborated by macrophage-like cell lines acts as competence factor(s) for BALB/c 3T3 cells. J Cell Physiol. 1982; 11 93-100
- 53 Pessa M E, Bland K I, Copeland III E M. Growth factors and determinants of wound repair. J Surg Res. 1987; 42 207-217
- 54 Ross R, Raines E W, Bowen-Pope D F. The biology of platelet-derived growth factor. Cell. 1986; 46 155-169
- 55 Sporn M B, Roberts A B. Peptide growth factors and inflammation, tissue repair, and cancer. J Clin Invest. 1986; 78 329-332
- 56 Barbul A, Caldwell M, Hunt TK (Eds.) Growth factors and other aspects of wound healing: Biological and clinical implications. Progr in Clin and Biol Research, Vol 266, Alan Liss New York; 1988
- 57 Brasken P, Renvall S, Sandberg M. Expression of epidermal growth factor and epidermal growth factor receptor genes in healing colonic anastomoses in rats. Eur J Surg. 1991; 157 607-611
- 58 Gagner M, Lacroix A, Prinz R A, Bolté E, Albala D, Potvin C, Hamet P, Kuchel O, Quérin S, Pomp A. Early experience with laparoscopic approach for adrenalectomy. Surgery. 1993; 114 1120-1125
- 59 Gartner M H, Benson J D, Caldwell M D. Insulin-like growth factors I and II expression in the healing wound. J Surg Res. 1992; 52 389-394
- 60 Jimenez S A, McArthur W, Rosenbloom J. Inhibition of collagen synthesis by mononuclear cell supernates. J Exp Med. 1979; 15 1421-1431
- 61 Kingsnorth A N, Vowles R, Nash J RG. Epidermal growth factor increases tensile strength in intestinal wounds in pigs. Br J Surg. 1990; 77 409-412
- 62 Laato M, Kähäri V M, Niinikoski J, Vuorio E. Epidermal growth factor increases collagen production in granulation tissue by stimulation of fibroblast proliferation and not by activation of procollagen genes. Biochem J. 1987; 247 385-388
- 63 Mateo R B, Reichner J S, Albina J E. Interleukin- 6 activity in wounds. Am J Physiol. 1994; 35 R1840-R1844
- 64 Rappolee D A, Mark D, Bandha M J, Werb Z. Wound macrophages express TGF-α and other growth factors in vivo. Analysis by mRNA phenotyping. Science. 1988; 241 708-712
- 65 Brasken P. Healing of experimental colon anastomosis. Eur J Surg. 1991; 157 ((Suppl 566)) 1-51
- 66 Jensen J A, Hunt T K, Scheuenstuhl H, Banda M J. Effect of lactate, pyruvate, and pH on secretion of angiogenesis and mitogenesis factors by macrophages. Lab Invest. 1986; 54 574-578
- 67 Trede M, Barth H O, Dietze W, Saeger H D, Stempfle B. Diagnostik und chirurgische Behandlung des Kolon- und Rektumkarzinoms. Therapiewoche. 1979; 29 1768-1779
- 68 Polverini P J, Cotran R S, Gimbrone jr M A, Unanue E R. Activated macrophages induce vascular proliferation. Nature. 1977; 269 804-806
- 69 Bary S. Klinische und experimentelle Untersuchungen zur Wundheilung des Dickdarmes unter besonderer Berücksichtigung der gewebeständigen Fibrinolyse und Kollagenolyse. Habilitationsschrift, Ludwig-Maximilians-Universität München; 1979
- 70 Brown L F, Dvorak A M, Dvorak H F. Leaky vessels, fibrin deposition, and fibrosis: A sequence of events common to solid tumors and to many other types of disease. Am Rev Respir Dis. 1989; 14 1104-1107
- 71 Ciano P S, Colvin R B, Dvorak A M, McDonagh J, Dvorak H F. Macrophage migration in fibrin gel matrices. Lab Invest. 1986; 54 62-70
- 72 Le Veen H H, Wapnick S, Falk G, Olivas O, Bhat D, Gaurdre M, Patel M. Effects of prophylactic antibiotics on colonic healing. Am J Surg. 1976; 131 47-53
- 73 Hawley P R, Faulk W P, Hunt T K, Dunphy J E. Collagenase activity in the gastro-intestinal tract. Br J Surg. 1970; 57 896-900
- 74 Jonsson T h, Högström H. Neutrophil-dependent decrease in early wound margin strength. Arch Surg. 1991; 126 1423-1426
- 75 Högström H, Haglund U, Zederfeldt B. Beneficial effect of proteinase inhibitors on early breaking strength of intestinal anastomoses. Acta Chir Scand. 1985; 151 529-532
- 76 Högström H, Haglund U. Neutropenia prevents decrease in strength of rat intestinal anastomosis: Partial effect of oxygen free radical scavengers and allopurinol. Surgery. 1986; 99 716-720
-
77 Gross E, Schaarschmidt K, Donhuijsen K, Beyer M, Eigler F W.
Die nahtlose Anastomose - histologische, biomechanische und mikroangiographische Untersuchung am Colon der Ratte. In: Streicher HJ (Hrsg) Chir Forum '86 für experimentelle und klinische Forschung. Springer Berlin, Heidelberg; 1986: 277-281 - 78 Wilker D, Sklarek J, Waldner H, Izbicki J R, Siebeck M. Untersuchung zur Frühphase der Anastomosenheilung unter besonderer Berücksichtigung von Peritonitis und Ischämie. Langenbecks Arch Chir. 1988; 373 217-221
- 79 Wilker D, Sklarek J, Waldner H, Posel P. Nahtfreie Anastomosen an der Ratte, am Kaninchen und am Schwein. Langenbecks Arch Chir. 1988; 373 91-96
- 80 Chowcat N L, Savage F J, Hembry R M, Boulos P B. Role of collagenase in colonic anastomoses: a reappraisal. Br J Surg. 1988; 75 330-334
- 81 Ellison G W, Jokinen M P, Park R D. End-to-end approximating intestinal anastomosis in the dog: a comparative fluorescein dye, angiographic and histopathologic evaluation. J Am Anim Hosp Assoc. 1982; 18 729-736
- 82 Benzer H, Blümel G, Piza F. Zusammenhänge zwischen fibrinolytischer Aktivität des Blutes und aseptischen Wundheilungsstörungen im Tierexperiment. Langenbecks Arch Klin Chir. 1963; 302 463-471
- 83 Korthauer H D. Die fibrinolytische Reaktion frischer Wundflächen. Med Klin. 1970; 65 1781-1784
- 84 Adamsons R, Enquist I F. The relative importance of sutures to the strength of healing wounds under normal and abnormal conditions. Surg Gynecol Obstet. 1963; 117 396-401
- 85 Golden T, Levy A H, O'Connor W T. Primary healing of skin wounds and incisions with a threadless suture. Am J Surg. 1962; 104 603-609
-
86 Jönsson K, Jiborn H, Zederfeldt B.
Mechanische Belastbarkeit von Dünndarmanastomosen mit und ohne Fäden. In: Thiede A, Hamelmann H (Hrsg) Moderne Nahtmaterialien und Nahttechniken in der Chirurgie. Springer Berlin, Heidelberg, New York; 1982: 145-150 - 87 Jönsson K, Jiborn H, Zederfeldt B. Breaking strength of small intestinal anastomoses. Am J Surg. 1983; 145 800-803
-
88 Scheele J.
Grundlagen der Anastomosenheilung. In: Scheele J (Hrsg) Fibrinklebung. Springer Berlin, Heidelberg, New York, Tokyo; 1984: 115-119 -
89 Zederfeldt B.
Anastomotic Healing. In: Eigler FW, Gross E, Vogt E (Hrsg) Die Anastomose am Gatrointestinaltrakt. TM Hameln; 1990: 13-16 - 90 Healey J E, Mc Bride C M, Gallager H S. Is serosa-to-serosa approximation necessary in intestinal anastomosis?. Surg Forum. 1964; 15 297-299
- 91 Jiborn H, Ahonen J, Zederfeldt B. Healing of experimental colonic anastomoses. IV. Effect of suture technique on collagen metabolism in the colonic wall. Am J Surg. 1980; 139 406-413
- 92 Lord M G, Broughton A C, Williams H TG. A morphologic study on the effect of suturing the submucosa of the large intestine. Surg Gynecol Obstet. 1978; 146 211-216
- 93 Högström H, Haglund U, Zederfeldt B. Suture technique and early breaking strength of intestinal anastomoses and laparotomy wounds. Acta Chir Scand. 1985; 151 441-443
- 94 Högström H, Haglund U. Postoperative decrease in suture holding capacity in laparotomy wounds and anastomoses. Acta Chir Scand. 1985; 151 533-535
- 95 Jönsson K, Jiborn H, Zederfeldt B. Changes in collagen content of the small intestinal wall after anastomosis. Am J Surg. 1985; 15 315-317
- 96 Jonsson T h, Högström H. Effect of suture technique on early healing of intestinal anastomoses in rats. Eur J Surg. 1992; 158 267-270
- 97 Fellows N M, Burge J, Hatch G S, Prince P B. Suture strength and healing strenght of end to end intestinal anastomoses. Surg Forum. 1951; 3 111-117
- 98 Vance J FA, Williams H TG. Mechanical support of healing small intestinal anastomoses by adhesions. Can J Surg. 1972; 15 101-107
-
99 Ascherl R, Scherer M, Stemberger A, Weichenmeier I, Blümel G.
Zusätzliche Nahtsicherung am Kolon mit verschiedenen Techniken der Fibrinklebung - experimentelle Untersuchungen an der Ratte. In: Scheele J (Hrsg) Fibrinklebung. Springer Berlin, Heidelberg, New York, Tokyo; 1984: 120-126 - 100 Gilmore O JA, Rosin R D, Exarchakos G, Ellis H. Colonic anastomosis healing. The effect of tropical povidone-iodine. Eur Surg Res. 1978; 1 94-104
- 101 Herrmann J B, Woodward S C, Pulaski E J. Healing of colonic anastomoses in the rat. Surg Gynecol Obstet. 1964; 119 269-275
- 102 Irvin T T, Hunt T K. The effect of trauma on colonic healing. Br J Surg. 1974; 61 430-436
- 103 Kortmann H, Bary von S. Demonstration of collagenolytic enzyme in postmortal human colon tissue. J Clin Chem Clin Biochem. 1977; 15 359-360
- 104 Irvin T T, Hunt T K. Reappraisal of the healing process of anastomosis of the colon. Surg Gynecol Obstet. 1974; 138 741-746
- 105 Adamsons R J, Musco F, Enquist I F. The chemical dimensions of a healing incision. Surg Gynecol Obstet. 1966; 123 515-521
- 106 Bary S v on, Kortmann H, Mair H, Meßmer K, Köpcke W. Die gewebeständige fibrinolytische Aktivität des Dickdarmes und ihr Einfluss auf die Wundheilung. Chir Forum Exp Klin Forsch 1979: 145-149
- 107 Cronin K, Jackson D S, Dunphy J E. Specific activity of hydroxyproline-tritium in the healing colon. Surg Gynecol Obstet. 1968; 126 1061-1065
- 108 Hawley P R. Causes and prevention of colonic anastomotic breakdown. Dis Colon Rectum. 1973; 16 272-277
- 109 Hesp F LEM, Hendriks T, Lubbers E JC. de Boer HHM. Wound healing in the intestinal wall. A comparison between experimental ileal and colonic anastomoses. Dis Colon Rectum. 1984; 27 99-104
- 110 Jiborn H, Ahonen J, Zederfeldt B. Healing of experimental colonic anastomoses. III. Collagen metabolism in the colon after left colon resection. Am J Surg. 1980; 139 398-405
- 111 Jönsson K, Jiborn H, Zederfeldt B. Mechanical and biochemical alterations in the intestinal wall adjacent to an anastomosis. Am J Surg. 1986; 151 387-390
- 112 Jönsson K, Jiborn H, Zederfeldt B. Collagen metabolism in small intestinal anastomosis. Am J Surg. 1987; 154 288-291
- 113 Jiborn H, Ahonen J, Zederfeldt B. Healing of experimental colonic anastomoses. I. Bursting strength of the colon after left colon resection and anastomosis. Am J Surg. 1978; 136 587-594
- 114 Thies H A, Richter U. Erworbener F XIII-Mangel und klinische Chirurgie. Med Welt. 1981; 32 250-255
- 115 Graham M F, Drucker D EM, Diegelmann R F, Elson C O. Collagen synthesis by human intestinal smooth muscle cells in culture. Gastroenterology. 1987; 92 400-405
- 116 Perr H A, Graham M F, Diegelmann R F, Downs R W. Cyclic nucleotides regulate collagen production by human intestinal smooth muscle cells. Gastroenterology. 1989; 96 1521-1528
- 117 Ross R, Bowen-Pope D F, Raines E W. Platelet-derived growth factor and its role in health and disease. Phil Trans R Soc Lond B. 1990; 327 155-169
- 118 Ahrendt G M, Gardner K, Barbul A. Loss of colonic structural collagen impairs healing during intra-abdominal sepsis. Arch Surg. 1994; 129 1179-1183
- 119 Blomquist P, Ahonen J, Jiborn H, Zederfeldt B. The effect of relative bowel rest on healing of colonic anastomoses. Collagen synthesis and content in the colonic wall after left colon resection and anastomosis in the rat. Acta Chir Scand. 1984; 15 677-681
- 120 Hendriks T H, Vereecken T H, Hesp F LEM, Schillings P HM, De Boer H HM. Loss of collagen from experimental anastomoses: early events. Exp Mol Pathol. 1985; 42 411-418
- 121 Jiborn H, Ahonen J, Zederfeldt B. Healing of experimental colonic anastomoses: the effect of suture technic on collagen concentration in the colonic wall. Am J Surg. 1978; 135 333-340
- 122 Irvin T T, Hunt T K. Pathogenesis and prevention of disruption of colonic anastomoses in traumatized rats. Br J Surg. 1974; 61 437-439
- 123 Eeckhout Y, Vaes G. Further studies on the activation of procollagenase, the latent precursor of bone collagenase. Effects of lysosomal cathepsin B, plasmin and kallikrein, and spontaneous activation. Biochem J. 1977; 166 21-31
- 124 Ohlsson K, Olsson I. The extracellular release of granulocyte collagenase and elastase during phagocytosis and inflammatory process. Scand J Haematol. 1977; 19 145-152
- 125 Weissmann G, Korchak H M, Perez H D, Smolen J E, Goldstein I M, Hoffstein S T. The secretory code of the neutrophil. J Reticuloendothel Soc. 1979; 26 ((Suppl.)) 687-700
- 126 Delaney P, Lalor D. Enzyme inhibition in colorectal surgery. Br J Surg. 1976; 63 23-24
- 127 Högström H, Haglund U, Zederfeldt B. Beneficial effect on intestinal anastomoses of S- 2441, a synthetic kallikrein-kinin antagonist. Experimental studies in the rat. Am J Surg. 1985; 15 312-314
- 128 Young H L, Wheeler M H. Collagenase inhibition in the healing colon. J R Soc Med. 1983; 76 32-36
- 129 Albini A, Adelmann-Grill B C. Collagenolytic cleavage products of collagen type I as chemoattractants for human dermal fibroblasts. Eur J Cell Biol. 1985; 36 104-107
- 130 Croce E, Azzola M, Russo R, Golia M, Angelini S, Olmi S. Laparoscopic liver tumour resection with the Argon Beam. End Surg. 1994; 2 186-188
- 131 Dayer J M, Zavadil-Grob C, Ucla C, Mach B. Induction of human interleukin 1 mRNA measured by collagenase - and prostaglandin E2-stimulating activity in rheumatoid synovial cells. Eur J Immunol. 1984; 14 898-901
- 132 Morgenstern L, Yamakawa T, Ben-Shoshan M, Lippman H. Anastomotic leakage after low colonic anastomosis. Clinical and experimental aspects. Am J Surg. 1972; 123 104-109
-
133 Ohlsson K.
Polymorphonuclear leukocyte collagenase. In: Woolley D, Evanson J (Eds.) Collagenase in normal and pathological connective tissue. Wiley Chichester; 1980: 209-222 - 134 Sellers A, Murphy G. Collagenolytic enzymes and their naturally occuring inhibitors. Int Rev Connect Tissue Res. 1981; 9 151-190
-
135 Starkey P H.
Elastase and cathepsin G. In: Barrett AJ (Ed.) The serine proteinases of human neutrophil leucocytes and spleen. Elsevier Amsterdam; 1977: 57-89 - 136 Virca G D, Metz G, Schnebli H P. Similarities between human and rat leukocyte elastase and cathepsin G. Eur J Biochem. 1984; 144 1-9
- 137 Young H L, Wheeler M H. Results of a prospective randomized doubleblind trial of aprotinin in colonic surgery. World J Surg. 1984; 8 367-373
- 138 Bary S, Kortmann H, Köpcke W. Berstungsdrucke des enterotomierten Rattencolons unter Proteinaseinhibition. Res Exp Med. 1976; 168 123-128
- 139 Högström H, Haglund U. Early decrease in suture line breaking strength. The effect of proposed collagenase inhibition. Res Exp Med. 1985; 185 451-455
-
140 Murphy G, Sellers A.
The extracellular regulation of collagenase activity. In: Barrett AJ (Ed.) Proteinases in mammalian cells and tissues. Elsevier Amsterdam; 1977: 1-9 - 141 Murphy G, Reynolds J J. Current views of collagen degradation. Progress towards understanding the resorption of connective tissues. Bio Essays. 1985; 2 55-60
- 142 Ryan G B, Majno G. Acute Inflammation. Am J Pathol. 1977; 86 183-276
- 143 Klein L, Rudolph R. H3-collagen turnover in skin grafts. Surg Gynecol Obstet. 1972; 135 49-57
- 144 Jonsson T h, Högström H. Diathermy-induced inflammation does not affect suture holding capacity of intestinal anastomoses. Eur Surg Res. 1991; 23 235-239
- 145 Gottrup F. Healing of incisional wounds in stomach and duodenum. Collagen distribution and relation to mechanical strength. Am J Surg. 1981; 141 222-227
- 146 Stromberg B V, Klein L. Collagen formation during the healing of colonic anastomoses. Dis Colon Rectum. 1982; 25 301-304
- 147 Leibovich S J, Ross R. The role of the macrophage in wound repair. A study with hydrocortisone and antimacrophage serum. Am J Pathol. 1975; 78 71-100
- 148 Sugarman B J, Aggarwal B B, Hass P E, Figari I S, Palladino jr M A, Shepard H M. Recombinant human tumor necrosis factor-α: Effects on proliferation of normal and transformed cells in vitro. Science. 1985; 23 943-945
- 149 Booth C C, Mc Intyre I, Mollin D L. Nutritional problems associated with extensive lesions of the distal small intestine in man. Quart J Med. 1964; 33 401-420
- 150 Ehrlich H P. Regulation der Wundheilung aus der Sicht des Bindegewebes. Chirurg. 1995; 66 165-173
-
151 Fietzek P, Kühn K.
The primary structure of collagen. In: Hall AH, Jackson DS (Eds.) International Review of Connective Tissue Research. Vol. 7. Academic Press New York, San Francisco, London; 1976: 1-60 - 152 Brasken P, Lehto M, Renvall S. Changes in the connective tissue composition of the submucosal layer of colonic anastomosis. Acta Chir Scand. 1989; 155 413-419
- 153 Bailey A J, Sims T J, Le Louis M, Bazin S. Collagen polymorphism in experimental granulation tissue. Biochem Biophys Res Comm. 1975; 66 1160-1165
- 154 Hubens G, Pauwels M, Hubens A, Vermeulen P, van Marck E, Eyskens E. The influence of a pneumoperitoneum on the peritoneal implantation of free intraperitoneal colon cancer cells. Surg Endosc. 1996; 1 809-812
- 155 Hudemann H. Chirurgisches Nahtmaterial. Fischer Jena; 1959
- 156 Lünstedt B. Moderne Nahtmaterialien in der Kolonchirurgie. Zuckschwerdt München, Bern, Wien, New York; 1992
- 157 Irvin T T, Edwards J P. Comparison of single-layer inverting, two-layer inverting, and everting anastomoses in the rabbit colon. Br J Surg. 1973; 6 453-457
- 158 Khoury G A, Waxman B P. Large bowel anastomoses. I. The healing process and sutured anastomoses. A review. Br J Surg. 1983; 7 61-63
- 159 Panton O NM, Smith J A, Bell G A, Forward A D, Murphy J, Doyle P W. The incidence of wound infection after stapled or sutured bowel anastomosis and stapled or sutured skin closure in humans and guinea pigs. Surgery. 1985; 98 20-24
- 160 Brasken P, Renvall S, Sandberg M. Fibronectin and collagen gene expression in healing experimental colonic anastomoses. Br J Surg. 1991; 78 1048-1052
- 161 Gay S, Martin G R, Muller P K, Timpl R, Kuhn K. Simultaneous synthesis of types I and III collagen by fibroblasts in culture. Proc Natl Acad Sci USA. 1976; 73 4037-4040
- 162 Gauperaa T, Seljelid R. Plasma fibronectin is sequestrated into tissue damaged by inflammation and trauma. Acta Chir Scand. 1986; 152 85-90
- 163 Johansson S, Rubin K, Höök M, Ahlgren T, Seljelid R. In vitro biosynthesis of coldinsoluble globin (fibronectin) by mouse peritoneal macrophages. FEBS Lett. 1979; 105 313-316
- 164 Tsukamoto Y, Helsel W, Wahl S. Macrophage production of fibronectin, a chemoattractant for fibroblasts. J Immunol. 1981; 127 673-678
- 165 Bitterman R B, Rennard S I, Adelberg S, Crystal R G. Role of fibronectin as a growth factor for fibroblasts. J Cell Biol. 1983; 97 1925-1932
- 166 Kurkinen M, Vaheri A, Roberts P J, Stenman S. Sequential appearance of fibronectin and collagen in experimental granulation tissue. Lab Invest. 1980; 43 47-51
- 167 Braucher R E, Kirsner J B. Regeneration of colon mucosa: A morphologic and histochemical study. Gastroenterology. 1962; 42 706-717
- 168 Houdart R, Lavergne A, Galian A, Hautefeuille P. Evolution anatomo-pathologique des anastomoses digestives bord à bord en un plan. Etude de 210 anastomoses coliques chez le rat du 2e au 180e jour. Gastroenterol Clin Biol. 1983; 7 465-473
- 169 Nusrat A, Parkos C A, Bacarra A E, Godowski P J, Delp-Archer C, Rosen E M, Madara J L. Hepatocyte growth factor/scatter factor effects on epithelia. Regulation of intracellular junctions in transformed and nontransformed cell lines, basolateral polarization of c-met receptor in transformed and natural intestinal epithelia, and induction of rapid wound repair in a transformed model epithelium. J Clin Invest. 1994; 93 2056-2065
- 170 Garner A, Hargreaves A W, Keddie N C. Colonic anastomosis: A histopathological study in the rabbit. Br J Surg. 1969; 56 673-676
- 171 Abercrombie M, Flint M H, James D W. Wound contraction in relation to collagen formation in scorbutic guinea-pigs. J Embryol exp Morph. 1956; 4 167-175
- 172 van Winkle W. Wound contraction. Surg Gynecol Obstet. 1967; 125 131-142
- 173 Ehrlich H P, Rajaratnam J BM. Cell locomotion forces versus cell contraction forces for collagen lattice contraction: An in vitro model of wound contraction. Tiss Cell. 1990; 22 407-417
- 174 Majno G, Gabbiani G, Hirschel B J, Ryan G B, Statkov P R. Contraction of granulation tissue in vitro: Similarity to smooth muscle. Science. 1971; 173 548-550
- 175 Müller G, Kieninger G, Breucha G, Bustamante I, Neugebauer W. Vergleichende Untersuchungen ein- und zweireihiger Anastomosen am Schweinedünndarm. Langenbecks Arch Chir. 1978; 346 37-45
- 176 Jansen A, Becker A E, Brummelkamp W H, Keeman J N, Klopper P J. The importance of the apposition of the submucosal intestinal layers for primary wound healing of intestinal anastomosis. Surg Gynecol Obstet. 1981; 152 51-58
- 177 Abramowitz H B, McAlister W H. A comparative study of small-bowel anastomoses by angiography and microangiography. Surgery. 1969; 66 564-569
- 178 Ravitch M M, Canalis F, Weinshelbaum A, McCormick J. Studies in intestinal healing: III. Observations on everting intestinal anastomoses. Ann Surg. 1967; 166 670-680
- 179 op den Winkel R. Primäre Dickdarmanastomosen bei Peritonitis. Eine Kontraindikation?. Hefte Unfallheilkd Bd. 188. Springer Berlin, Heidelberg, New York, London, Paris, Tokyo; 1988
- 180 Houdart R, Lavergne A, Valleur P, Villet R, Hautefeuille P. Vascular evolution of single-layer end-on colonic anastomosis. Dis Colon Rectum. 1985; 28 475-480
- 181 Schäfer K, Göller M, Stanka P, Ernst R, Zumtobel V. Revaskularisation von Kolonanastomosen. Langenbecks Arch Chir. 1991; 376 163-171
- 182 Nakanishi H. Experimental gut anastomoses and their revascularization. Aust NZ J Surg. 1975; 45 309-314
- 183 Waninger J, Kauffmann G, Schmidt J, Gorenflo M. Mikroangiographische Befunde experimenteller Darmanastomosen. Fortschr Röntgenstr. 1987; 147 87-91
- 184 Herzog B. Die Darmnaht. Eine tierexperimentelle Studie und Erfahrungen mit einer eigenen Nahttechnik. Aktuelle Probleme in der Chirurgie, Bd. 20, Huber Bern, Stuttgart, Wien; 1974
- 185 Myllärniemi H. Healing and adhesion formation of peritoneal wounds. An angio-, histoangiographic and ultrastructural study. Acta Chir Scand. 1973; 139 258-263
- 186 Hansen H, Sommer H J, Eichelkraut W. Die Durchblutung handgenähter und geklammerter Colonanastomosen. Langenbecks Arch Chir. 1987; 37 141-151
- 187 Shikata J, Shida T. Experimental studies by the resin-casting method on the vascular structure of the colon following stapler anastomoses. Dis Colon Rectum. 1985; 28 341-346
- 188 Myllarniemi H, Karppinen V. Vascular pattern of peritoneal adhesions. Br J Surg. 1968; 55 605-608
- 189 Langer S, Pesendorfer H, Breining H, Cen M. Klinische und tierexperimentelle Studien zur Anastomosentechnik in der Darmchirurgie. Langenbecks Arch Chir. 1974; 335 309-320
-
190 Hernandez-Richter H J, Struck H.
Wundheilung und ihre Störungen, Chirurgische Infektionen. In: Lindenschmidt TO (Hrsg) Pathophysiologische Grundlagen der Chirurgie. 2. Auflage, Thieme Stuttgart; 1975: 124-135 -
191 Miller E J, Gay S.
Collagen structure and function. In: Cohen IK, Diegelman RF, Lindblad WJ (Eds.) Wound healing: Biochemical and clinical aspects. Saunders Philadelphia; 1992: 130-151
PD Dr. G. Meyer
Chirurgische Klinik und Poliklinik
Klinikum Großhadern
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81377 München
Phone: 089 - 7095 - 3570
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