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
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PD Dr. G. Meyer
Chirurgische Klinik und Poliklinik
Klinikum Großhadern
Marchioninistr. 15
81377 München
Telefon: 089 - 7095 - 3570
Fax: 089 - 7095 - 8894
eMail: meyerg@gch.med.uni-muenchen.de
