Anastomosenheilung

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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