This journal is
indexed in Scopus
Year 2018 Vol. 26 No 2
M.G. RYABKOV 2, E.B. KISELEVA 1, N.D. GLADKOVA 1, M.S. BALEEV 2, E.L. BEDERINA 2, E.E. LUKOYANYCHEV 2, A.A. MIRONOV 1, I.L. DEZORTSEV 2, V.V. BESCHASTNOV 2
THE ROLE OF INTRAMURAL BLOODSTREAM DYSFUNCTION IN THE DEVELOPMENT OF SMALL INTESTINE ISCHEMIC NECROSIS
Nizhny Novgorod State Medical Academy 1,
City Clinical Hospital ¹ 30, Nizhny Novgorod 2,
The Russian Federation
Objective. To study experimentally the mechanisms of intramural bloodstream dysfunction and small bowel necrosis development in case of the acute mesenteric ischemia.
Methods. Acute complete mesenteric ischemia was modelled in laboratory animals by ligating a. mesenterica cranialis. The OCT-based microangiography technique was used to monitor bowel microcirculation till the visual signs of its non-viability appeared. Then the bowel was resected, the degree of ischemic lesion was histologically evaluated.
Results. In occlusion of mesenteric arteries by the moment when macroscopic nonviability signs appear, the ischemic damage without necrosis spreads out to 22.2% of the bowel length and mucous tunic necrosis and transmural necrosis spread out to 38.1% and 39.7% of the bowel length correspondingly. While comparing the histological preparations and OCT images, the features of OCT-microangiograms were described in different degrees of ischemic lesion and bowel necrosis. According to OCT-microangiography, in 60.3% of the wall of the ischemic intestine the number of functioning vessels remained normal. The decrease in the length of functioning vessels (by 5.6%, p=0.029), the total area of the vascular bed (by 4.5%, p=0.032) and the average vascular density (by 5.1%, p=0.001) occurred only in the intestinal wall with transmural necrosis. The mechanism of the superficial bowel necrosis development was a decrease in the proportion of small diameter vessels (p=0.029) against the background of the preserved microcirculation.
Conclusions. The attempt to recommence hemocirculation in the bowel arteries which are traditionally considered empty is the basis of modern surgical treatment of the mesenteric ischemia. However, the authors came to the conclusion that for 38% of ischemic bowel the blood supply remains at a normal level till necrosis development. This fact seems important for improving results of surgical treatment of acute mesenteric ischemia because it gives the opportunity to save a part of the bowel without thrombectomy. In these cases the OCT-based microangiography method can be an effective noninvasive tool for functioning blood vessels visualization and control of treatment results.
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605157, The Russian Federation,
Nizhny Novgorod, Berezovskaya Str., 85À,
City Clinical Hospital ¹ 30
of Moscow District,
Surgical Unit ¹ 2,
Tel.: +7 905 012-21-50,
Ryabkov Maxim G.
Ryabkov Maxim G., MD, Associate Professor, Consultant of the Surgical Unit ¹ 2, City Clinical Hospital ¹ 30 of Moscow District, Nizhny Novgorod, Russian Federation.
Kiseleva Elena B., PhD, Researcher of the Laboratory of Studying the Optical Properties of Tissues of SRI of Biomedical Technologies, Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russian Federation.
Gladkova Natalia D., MD, Professor, Deputy Director of SRI of Biomedical Technologies, Nizhny Novgorod State Medical Academy, Russian Federation.
Baleev Mixail S., Surgeon, the Surgical Unit ¹ 2, City Clinical Hospital ¹ 30 of Moscow District, Nizhny Novgorod, Russian Federation.
Bedrina Evgenia L., Pathologist, City Clinical Hospital ¹ 30 of Moscow District, Nizhny Novgorod, the Chief Out-Of-Staff Specialist (Pathologist) of the Department of Health, Nizhny Novgorod, Russian Federation.
Lukoyanychev Egor E., PhD, Surgeon, City Clinical Hospital ¹ 30 of Moscow District, Nizhny Novgorod, Russian Federation.
Mironov Andrey A., PhD, Senior Researcher of the Central Research Laboratory, Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russian Federation.
Dezortsev Ilya L., Surgeon, City Clinical Hospital ¹ 30 of Moscow District, Nizhny Novgorod, Russian Federation.
Beschastnov Vladimir V., MD, Associate Professor, Surgical Unit N2, Consultant of the Surgical Unit ¹ 2, City Clinical Hospital ¹ 30 of Moscow District, Nizhny Novgorod, Russian Federation.