ASSESSMENT OF INTRAOPERATIVE INTESTINAL VIABILITY WITH FLUORESCEIN

The assessment of intraoperative intestinal viability and the determination of ischemic borders are difficult in situations where the demarcation line is not clear in intestinal disease due to mesenteric ischemia. In this experimental study, the value of fluorescein fluorescence, which is a helpful diagnostic procedure in the detection of the degree of damage in ischemic injuries of the intestine in the intraoperative period was sought by means of forming various mesenteric ischemia models. A strangulation group, a superior mesenteric artery ligation group and a control group were formed in Wistar-Albino male rats. Two hours later, intestinal viability was assessed via intraoperative observation findings. Fluorescein (Fluorescite Injection ampul 10%) was given intravenously with a dose of 15 mg/kg through the tail vein. Two-three minutes later, the intestinal viability was assessed in a dark room under wood light of 3600 A. In all groups, intraoperative observation findings and fluorescein fluorescence findings were compared. Histopathologic evaluation was performed in the samples taken from ischemic or normal intestines of all of the subjects. The accuracy of the methods was tried to be assessed by means of performing histopathologic evaluation. In the study, the sensitivity of the fluorescein fluorescense method in showing intestinal ischemia was found to be 100%, the specificity 92% and the accuracy 96%. In the clinical assessment, the same values were found to be 76%, 92%, 83%, respectively. In intestinal ischemic disorders such as embolism, thrombosis, and strangulation; if intestinal viability is questionable, fluorescein fluorescence which is a cheap and practical method can be useful in determining resection borders and preventing unwarranted intestinal resections.

FLUORESSEÝN ÝLE ÝNTRAOPERATÝF BARSAK CANLILIÐININ DEÐERLENDÝRÝLMESÝ

Mezenter iskemisine baðlý barsak hastalýðýnda demarkasyon hattýnýn net olmadýðý durumlarda intraoperatif barsak canlýlýðýnýn deðerlendirmesi ve sýnýrlarýnýn tespiti güçtür. Bu deneysel çalýþmada, deðiþik mezenterik iskemi modelleri oluþturularak barsak iskemi derecesinin intraoperatif olarak deðerlendirilmesinde yardýmcý bir taný yöntemi olan flouressein flouresansýnýn yeri araþtýrýldý.: Wistar - Albino erkek ratlarda strangülasyon, superior mezenterik arter ligasyonu ve kontrol gruplarý oluþturuldu. Ýki saat sonra intraoperatif gözlem bulgularý ile barsaklarýn canlýlýðý deðerlendirildi. Kuyruk veninden 15 mg/kg fluoressein intravenöz verildi. Ýki-üç dakika sonra karanlýk odada 3600 A Wood ýþýðý altýnda flouressein flouresans derecesine göre barsak canlýlýðý deðerlendirildi. Bütün gruplarda intraoperatif gözlem bulgularý ve flouressein flouresans bulgularý karþýlaþtýrýldý. Tüm deneklerde, transmural nekroz varlýðý düþünülen veya canlý olarak kabul edilen barsak segmentlerinden örnekler alýnarak histopatolojik deðerlendirme yapýldý. Flouressein flouresans yönteminin barsak iskemisini göstermede duyarlýlýðý % 100, özgüllüðü %92 ve doðruluk oraný %96 olarak saptandý. Klinik deðerlendirmede ayný deðerler sýrasýyla %76, %92, %83 olarak tespit edildi. Mezenter iskemisine yol açan emboli, tromboz, strangülasyon gibi barsak canlýlýðýnýn þüpheli olduðu vakalarda ucuz ve pratik bir yöntem olan flouressein flouresansýnýn kullanýlmasý rezeksiyon sýnýrlarýnýn tayininde ve gereksiz barsak rezeksiyonunun önlenmesinde faydalý olabilir.