Ulus Travma Acil Cerrahi Derg. 2007; 13(2): 94-100

Peritoneal adezyon oluþumu dekspantenol uygulamasýyla azaltýlabilir mi? Deneysel çalýþma

Yusuf Akdeniz, Ömer Rýdvan Tarhan, Ýbrahim Barut
Süleyman Demirel Üniversitesi Týp Fakültesi, Genel Cerrahi Ana Bilim Dalý, Isparta, Türkiye

AMAÇ: Periton, adezyonlarý yýkan bir fibrinolitik aktiviteye sahiptir. Ýskeminin eþlik ettiði periton yaralanmalarý bu fibrinolitik aktiviteyi bozar. Pantotenik asitin (B5 vitamini) alkol þekli olan dekspantenol lokal uygulamalarda mitoz bölünmeyi artýrarak yaranýn iyileþmesini hýzlandýrýr. Hipotezimiz dekspantenolün peritoneal adezyon oluþumunu azaltabileceðidir. GEREÇ-YÖNTEM: Sýçanlarda çekumun antimezenterik kýsmý gazlý bez ile silindi. Kontrol grubuna tedavi uygulanmadý. Deney gruplarýna dekspantenol intraperitoneal (ÝP) (n=15, 25 mg/kg) ya da intravenöz (ÝV) olarak (n=15, 25 mg/kg, iþlem sonrasý 9 gün boyunca) verildi. Postoperatif 10. günde adezyonlar derecelendirildi; doku plazminojen aktivatörü (tPA) aktivitesi ve düzeyleri, plazminojen aktivatör inhibitör tip 1 (PAI-1), tPA/PAI-1 kompleks ve hidroksiprolin düzeyleri peritonda ölçüldü.
BULGULAR: Adezyon formasyonu ÝP dekspantenol grubunda, kontrol grubuna göre azalmýþtý (p=0,034). Kontrol grubuyla karþýlaþtýrýldýðýnda, deney gruplarýndaki tPA aktivite ve konsantrasyon düzeyleri, tPA/PAI-1 kompleks düzeylerinde artýþ saptandý. PAI-1 düzeyleri her üç grup arasýnda da benzerdi. Peritoneal hidroksiprolin seviyelerinde, kontrol grubuna göre, ÝP dekspantenol grubunda deðiþme saptanmazken ÝV dekspantenol grubunda azalma görüldü (sýrasýyla p=0,84, p=0,009).
SONUÇ: Bu sonuçlara göre, dekspantenol intraperitoneal olarak uygulandýðýnda muhtemelen peritoneal fibrinolitik aktiviteyi etkileyerek adezyon oluþumunu azaltabilmektedir.

Anahtar Kelimeler: Dekspantenol, peritoneal adezyon; peritoneal fibrinoliz; tPA; PAI-1

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Can dexpanthenol prevent peritoneal adhesion formation? An experimental study

Yusuf Akdeniz, Ömer Rýdvan Tarhan, Ýbrahim Barut
Department Of General Surgery, Suleyman Demirel University, Isparta, Turkey

BACKGROUND: Peritoneum has an intrinsic fibrinolytic activity that breaks the peritoneal adhesions. Ischemic peritoneal injuries interfere with this fibrinolytic activity. Local application of dexpanthenol, the alcohol form of pantothenic acid (vitamin B5) accelerates wound healing by increasing mitosis. We hypothesized that dexpanthenol would decrease peritoneal adhesions. METHODS: In rats, antimesenteric border of cecum was abraded with gauze. No medication was given to the control group (n=15). Dexpanthenol was administered intraperitoneally (IP) (n=15, 25 mg/kg, before abdominal closure) or intravenously (IV) (n=15, 25 mg/kg, for 9 days after operation) in the experiment groups. On postoperative day 10, adhesions were graded; activities and concentrations of tissue plasminogen activator (tPA), plasminogen activator inhibitor type 1 (PAI-1), tPA/PAI-1 complex and hydroxyproline contents were determined in peritoneum. RESULTS: Adhesion formation was decreased in IP dexpanthenol group compared with control group (p=0.034). tPA concentration and activity and tPA/PAI-1 complex levels were increased in the treated groups compared to controls. PAI-1 levels were similar among the three groups. Peritoneal hydroxyproline levels were lower in animals receiving IV dexpanthenol compared with control animals and in addition, they remained unchanged in IP dexpanthenol treated group (p=0.009, p=0.84, respectively).
CONCLUSION: Our results suggest that dexpanthenol administration through IP may reduce peritoneal adhesion formation probably by altering peritoneal fibrinolytic activity.

Keywords: Dexpanthenol, peritoneal adhesion; peritoneal fibrinolysis; tPA; PAI-1

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