羧甲基壳聚糖冲洗液预防大鼠术后腹膜粘连

背景：开腹手术后常造成腹膜粘连，给患者带来极大的痛苦，至今仍没有发现一种有效的药物或方法能够完全预防腹膜粘连，羧甲基壳聚糖是具有优良生物相容性和生物降解性，是理想的预防腹腔粘连的生物材料。目的：研究羧甲基壳聚糖防粘连冲洗液预防大鼠术后腹膜粘连的效果，探讨其防粘连的作用机制。 方法：取56只成年雄性Wistar大鼠建立盲肠刮伤/腹壁缺损的动物手术模型，随机分为4组，分别以生理盐水、医用透明质酸、医用几丁糖和羧甲基壳聚糖防粘连冲洗液涂布于盲肠刮伤面及腹壁缺损处。术后2，3周进行粘连分级和病理组织观察，同时测定转化生长因子β1表达、血液中白细胞数量及羟脯氨酸含量。 结果与结论：透明质酸组、几丁糖组粘连分级评分结果优于生理盐水组（P 〈0.05），羧甲基壳聚糖组粘连分级评分结果明显优于生理盐水组（P 〈0.01）。血常规、苏木精-伊红染色和转化生长因子β1免疫组织化学染色结果显示，羧甲基壳聚糖防粘连冲洗液与医用透明质酸和医用几丁糖一样具有较好的组织相容性，可通过降低转化生长因子β1的表达、减少羟脯氨酸的合成，抑制腹腔粘连发生的程度和范围。

Preventive effect of carboxymethyl chitosan solution on postoperative peritoneal adhesions in a rat model

BACKGROUND：The patients are suffering from peritoneal adhesions that are caused after abdominal operation. As so far, there is stil no effective drug or method that can completely prevent peritoneal adhesions. Carboxymethyl chitosan is a biocompatible and biodegradable biomedical material with anti-adhesion effects, which is an ideal biomaterial for prevention of peritoneal adhesion theoreticaly. OBJECTIVE：To investigate the novel anti-adhesion properties of carboxymethyl chitosan anti-adhesion solution on the prevention of postsurgical adhesion in vivo in a rat model. METHODS：Fifty-six adult male Wistar rats were randomly divided into four groups： 0.9% normal saline solution （group A）, hyaluronic acid gels （group B）, medical chitosan gels （group C） and carboxymethyl chitosan anti-adhesion solution （group D）. The model of postoperative intestinal adhesion was established by making cecal scratches/abdominal wal defects. Al the rats were scarified after 2 or 3 weeks. Whole blood was colected by cardio-puncture, lung tissue and tissue adhesion were stripped. The incidence and degree of adhesions, histological effects, expression of transforming growth factor-β1 （TGF-β1）, the amounts of hydroxyproline and white blood cels were observed. RESULTS AND CONCLUSION：The formation of postsurgical adhesions in groups B, C and D was significantly decreased, which was lighter than that of group A （P 〈 0.05）. Furthermore, the adhesion formation in group D was＆nbsp;significantly decreased in comparison with group A （P 〈 0.01）. At the same time, the levels of transforming growth factor-β1, hydroxyproline and white blood cels in group D were lighter than those of group A （P 〈 0.05）, and the histopathological results indicated that a marked reduction in inflammatory cels and fibroblasts. Carboxymethyl chitosan anti-adhesion solution can effectively reduce the degree and incidence of postoperative adhesion, and it is becoming a promising drug delivery system in the context of postsurgical anti-adhesion.