Grundlagen und Biologie der Anastomosenheilung

Zusammenfassung

Die regelhaft ablaufende Anastomosenheilung am Gastrointestinaltrakt entspricht im Wesentlichen den Mechanismen der Wundheilung. Sie verläuft in drei sich überlappenden Phasen, aber schneller als die allgemeine Wundheilung. Ausgelöst werden diese Vorgänge durch das chirurgische Trauma. Folge jeder Anastomosierung ist eine mehr oder weniger ausgeprägte Entzündungsreaktion, die ihr Maximum in den ersten sieben Tagen erreicht. Das Ausmaß der Entzündung bestimmt entscheidend den Ablauf der Heilung. Dementsprechend können die einzelnen Phasen in Ausprägungsgrad und Dauer variieren. Makrophagen spielen regulativ eine entscheidende Rolle. Die exsudative Phase ist geprägt durch ein Ödem und die Exsudation von Fibrin und Blutbestandteilen mit Einwanderung von Entzündungszellen sowie Fibrinstabilisierung. In der proliferativen Phase findet die Bindegewebseinsprossung mit Gefäß- und Fibroblastenproliferation sowie Kollagenbildung statt. Die reparative Phase ist durch die Stabilisierung des Kollagens mit Reorganisation der Darmwandschichten charakterisiert. Resultat ist immer eine Defektheilung mit Narbenbildung. Im Zusammenhang mit dem Kollagenstoffwechsel kommt es bis zum dritten bis vierten Tag zu einem deutlichen Stabilitätsverlust. Nach 14 Tagen wird schließlich auch ohne unterstützendes Nahtmaterial eine ausreichende Stabilität erreicht.

Abstract

Anastomotic healing of the gastrointestinal tract corresponds basically the mechanisms of wound healing in general. There are as well three overlapping phases, but restitution is faster than regular wound healing. The surgical trauma causes the inition of this process. Anastomotic suture is followed by a more or less severe pronounced inflammatoric reaction, that reaches its maximum within the first seven days. The range of the inflammatoric reaction determines essentially the process of healing. Depending on this, phases can vary in occurrence and duration. Macrophages play the most important role in regulation. The exsudative phase is minted by edema and exsudation of fibrin and other blood components. Additionally there is an invasion of inflammatoric cells. Stabilisation of the fibrin clot takes place. The following proliferative phase showes germination of connective tissue, fibroblastic proliferation and synthesis of collagen as well as neovascularisation. The reparative phase finally is characterized by stabilisation and maturation of collagen and results in reorganisation of the bowel's walls. The outcome is always a defect healing with scar formation. Concerning the collagen-metabolism, there is a notable loss in stability till the third to forth postoperative day. After fourteen days stability is sufficient without the need of supporting suture material.

Schlüsselwörter

Anastomose - Anastomosenheilung - Gastrointestinaltrakt - Phasen der Wundheilung - Anastomoseninsuffizienz

Key words

anastomosis - anastomotic healing - gastrointestinal-tract - phases of wound healing - anastomotic leak

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