凝胶化改性壳聚糖膜预防腹膜粘连的效果研究

目的对比研究凝胶化改性壳聚糖膜和透明质酸钠对腹膜粘连的预防作用。方法SD大鼠80只,随机分成4组：假手术对照组（A组）,生理盐水对照组（B组）,凝胶化改性壳聚糖膜组（C组）,透明质酸钠组（D组）。利用大鼠蚓突盲端制作创伤性腹膜粘连模型,然后每组分别用相应的方法处理创面,处理后第2周和第4周打开腹腔,以Bhada分级法评定蚓突盲端的粘连程度,并对盲端组织行羟脯胺酸（OHP）水平测定和病理组织学检查。结果术后第2周和第4周,C,D组的粘连程度均显著轻于B组（P=0．001～0．013）,OHP水平显著低于B组（P=0．037～P〈0．001）;C组和D组比较,粘连程度分级的差异两组间无显著性意义（P〉0．05）,但OHP含量C组显著低于D组（P=0．005,0．002）。病理学检查：A组所有大鼠蚓突组织无明显的病理改变,B组术后第2周时处理侧浆膜面有明显的炎症细胞浸润和纤维组织增生,术后第4周局部主要以纤维组织增生为主;相应的病理改变C,D组较B组明显减轻,C组的病理改变又明显轻于D组。结论凝胶化改性壳聚糖膜具有明显的抗腹膜粘连作用,且此作用较透明质酸钠具有优势。     

化学改性壳聚糖膜预防不同类型腹膜粘连的实验研究

目的对比研究化学改性壳聚糖膜对四种不同原因所致的大鼠腹膜粘连的预防作用。方法将壳聚糖行化学改性,制成厚60μm的膜消毒后备用。SD大鼠200只,随机分成假手术对照组（A组）、创伤致粘连组（B组）、滑石粉致粘连组（C组）、结扎血管致粘连组（D组）及感染致粘连组（E组）。各组分别用相应的方法来处理大鼠蚓突盲端．再将每组大鼠分成对照组和实验组．对照组大鼠直接关腹,实验组用凝胶化改性壳聚糖膜覆盖蚓突盲端浆膜面．然后关腹。处理后2周和4周后打开腹腔,以Bhatia分级法评定蚓突盲端的粘连程度,并对盲端组织行羟脯胺酸（hydroxyproline,OHP）、组织型纤溶酶原激活剂tissue—type plasminogen activatior,t—PA）和纤溶酶原激活物抑制因子（plasminogen activator inhibitor,PAI）水平测定,对腹腔液行t—PA、PAI测定。结果①粘连程度和OHP水平：术后2周和4周,B、D、E组中实验组的粘连程度、OHP水平均分别显著低于对照组（P〈0．05）,而A、C组中的实验组和对照组间差异均无统计学意义（P〉0．05）;②t-PA、PAI水平：术后2周和4周,A组、C组和D组的蚓突组织和腹腔液t—PA、PAI水平．实验组和对照组间差异均无统计学意义（P〉0．05）;B组、E组中实验组t—PA水平均显著高于对照组（P〈0．05）,而PAI水平则显著低于对照组（P〈0．05）。结论化学改性壳聚糖膜时创伤、缺血及感染所致的腹膜粘连有明显的预防作用,而对滑石粉所致的腹膜粘连则作用不明显;对不同原因所致的腹膜粘连．可以用来准确衡量组织粘连程度的指标也不尽相同。     

羟丁基壳聚糖预防大鼠腹腔粘连的实验研究

目的 探讨羟丁基壳聚糖对大鼠术后腹腔粘连的预防作用.方法 清洁级SD大鼠90只,雌雄各半,体重250～280 g,随机分为3组(n=30).采用纱布摩擦盲肠浆膜面制作腹腔粘连动物模型后,A、B组分别于盲肠表面喷涂2 mL浓度为2%的羟丁基壳聚糖溶液及透明质酸钠凝胶,C组旷置30 s后关腹.术后观察大鼠一般情况,术后2、4剧每组各取15只大鼠,行大体观察及组织学观察,双盲法行粘连程度分级.术后4周A、C组透射电镜观察创伤处盲肠壁的超微结构.结果 术后人鼠均存活至实验完成.术后2周,A、B组腹腔粘连程度较轻,纤维结缔组织及胶原增生较少,C组腹腔粘连较重,纤维结缔组织大量增生;根据Nair五级分级标准及组织学观察分级A、B组与C组差异有统计学意义(P＜0.05),A、B组间差异无统计学意义(P＞0.05).术后4周,A组粘连程度轻,纤维结缔组织及胶原增生少,C组腹腔粘连严重,纤维结缔组织及胶原大量增生,B组介于两者之间,3组分级差异有统计学意义(P＜0.05).透射电镜观察结果显示:A组成纤维细胞不活跃,胶原纤维较纤细,排列稀疏;C组成纤维细胞活跃,胶原纤维致密、紊乱.结论 羟丁基壳聚糖可显著减少大鼠腹腔术后纤维结缔组织增生,明显抑制成纤维细胞的活性,具有长时间预防腹腔粘连的作用.     

维拉帕米对胶原基因表达及大鼠腹膜粘连形成的影响

目的探讨维拉帕米(Verapamil)在胶原基因表达及大鼠腹膜粘连形成中的作用.方法通过造成腹壁和盲肠浆膜的均一缺损制成大鼠粘连模型;关腹前注入1ml生理盐水或维拉帕米(0.002 kg/L);术后7 d进行粘连评分;采用逆转录-聚合酶链反应(RT-PCR)方法测定各组织标本Ⅰ(α2)、Ⅲ(α1)型胶原基因mRNA的表达.结果与正常腹膜相比,模型组和生理盐水组粘连组织Ⅰ(α2)、Ⅲ(α1)型胶原基因mRNA表达显著增强(0.64±0.17至4.37±0.83、3.56±0.57,P＜0.01;0.06±0.02至0.39±0.12、0.47±0.21,P＜0.01);与模型组或生理盐水组相比,维拉帕米组大鼠粘连显著减轻,同时Ⅰ(α2)、Ⅲ(α1)型胶原基因mRNA表达显著减弱(0.77±0.21,0.09±0.03,P＜0.01).结论粘连形成过程中胶原基因表达增强,抑制胶原基因表达能减轻粘连程度.     

腹膜粘连的预防研究进展

术后腹膜粘连是腹部手术的常见并发症，术前不可预测。本文对其预防研究进展作了介绍。改进外科手术技巧可降低其发生率和严重程度，使用各种辅助治疗是必要的，近期采用的损伤面间置隔离物有较好的防粘连效果。     

靶向间皮角质细胞生长因子预防大鼠术后腹膜粘连的实验研究

目的 研究角质细胞生长因子(keratinocyte growth factor,KGF)通过促进间皮再生及影响腹膜纤溶活性而对大鼠腹膜粘连形成的预防作用.方法 30只雌性SD大鼠,平均分为3组,KGF组、阳性对照组和阴性对照组,每组10只.各组于术后第7天处死大鼠,参考Leach评分系统评估腹膜粘连程度,并采用免疫组化法来测定盲肠粘连组织中tPA、PAI-1表达情况.采用HE染色光镜观察组织变化情况,苦味酸天狼猩红染色-偏振光观察Ⅰ、Ⅲ型胶原蛋白表达.结果 KGF组胶原纤维变少,KGF组粘连总评分为(4.8±1.0)低于阳性对照组(7.6±1.0),两者差异有统计学意义(t=5.422,P＜0.01);KGF组Ⅰ型胶原纤维平均灰度值(69±11)明显高于阳性对照组(55±9)(t=3.214,P＜0.01);KGF组Ⅲ型胶原纤维平均灰度值(48±7)与阳性对照组(50±10)相比,差异无统计学意义(t=0.481,P＞0.05).免疫组化结果 示KGF组tPA表达水平(88±4.0)明显高于阳性对照组(112±4.0)和阴性对照组(101±2.0)(F=109.1,P＜0.01),PAI-1表达水平在3组之间的差异无统计学意义(F=1.391,P＞0.05).结论 KGF可促进腹膜间皮修复和增加间皮纤溶能力,抑制胶原沉积,从而降低术后粘连强度.

Abstract：

Objective To investigate the effects of keratinocyte growth factor on peritoneal adhesion formation in rats. Methods Thirty Sprague-Dawley( SD) female rats were randomly assigned to 3 groups, KGF group( n = 10), positive control group (n = 10) , and negative control group (n = 10). Seven days after surgery, rats were killed and the adhesion degree was evaluated by Leach scale. Immunohistochemical technique was used to identify the expression of tPA and PAI-1. Stained with HE,the histomorphology changes of the adhesion tissue were observed by light microscope. Picrosirius-polarization method was used to observe the expression of type Ⅰ or Ⅲ collagens in two groups. Results In the KGF group,lower collagen fibers were noted and the gross adhesion scores was significantly lower than that in positive control group (4. 8 ± 1. 0 vs 7. 6 ± 1. 0; t = 5.422; P ＜ 0. 01). The expression level of type Ⅰ collagens was significantly lower in the KGF group than in positive control group (69 ±11 versus 55 ±9;t = 3. 214 ;P ＜0. 01) ,but there was no significant difference in the expression of type Ⅲ collagens among the two groups (48 ± 7 versus 50 ± 10; t = 0. 481; P ＞ 0. 05). The immunohistochemistry showed that the expression of tPA significantly increased in the KGF group than in positive control group and negative control group(88 ±4.0 versus 112 ±4.0, 101 ±2.0;F = 109. l,P＜0. 01) , However, no statistically significant difference for the expression of PAI-1 was noted among the three groups ( F = 1. 391, P ＞ 0. 05). Conclusions Keratinocyte growth factor promotes mesothelium repair, increases mesothelial fibrinolytic activity, inhibits the deposition of collagen and reduces the intensity of postoperative adhesions.     

重组链激酶腹腔灌注预防大鼠腹腔粘连的实验研究

目的：探讨基因重组链激酶（r-SK）对腹腔粘连的预防价值。方法：30只SD大鼠手术制作腹腔粘连模型后随机分3组，SK组给予r-SK、NS组给予生理盐水腹腔灌注，另一组空白对照（N组），术后1周，2周分别处死动物，观察腹腔粘连程度，并取腹膜和网膜组织进行HE、嗜银染色和纤维蛋白、CD34免疫组化染色，镜下观察组织学改变情况。结果：SK组中，无粘连33.3%，I度粘连61.1%，Ⅱ度粘连5.6%；NS组和N组中均有腹腔粘连，其中2/3表现为Ⅱ～Ⅳ度粘连，镜下表现，腹膜和网膜组织HE，嗜银染色和纤维蛋白，CD34免疫组化染色，显示KS组炎症反应较轻，NS组和N组均呈明显急性炎症反应。结论：r-SK腹腔灌注有减轻大量术后腹腔粘连的作用，有一定的量-效关系。     

壳聚糖膜预防术后腹腔粘连及其作用机制的研究

目的研究壳聚糖防粘连膜在大鼠粘连模型中的防止术后腹腔内腹膜粘连的作用,并对其可能的作用机制进行探讨。方法sD大鼠60只,随机分成两组,对照组（肠粘连模型组）n=30;实验组（壳聚糖薄膜组）n=30。比较两组动物在术后第1天,3天,7天,60天,90天的时间段腹腔粘连发生率和程度,并用光学显微镜和电镜对腹腔内粘连的标本进行病理观察,比较腹膜的反应情况。结果对照组的各时间段发生的粘连程度与粘连的发生率比实验组都要高。实验组的重新腹膜化比对照组明显要完整。结论壳聚糖防粘连膜能明显地减少腹腔术后粘连的发生。     

医用透明质酸钠凝胶对人工流产后预防宫腔粘连的作用

目的探讨医用透明质酸钠凝胶对人工流产后预防宫腔粘连的作用。方法回顾性分析本院宫腔粘连患者的临床资料,按治疗方法的不同．随机分为治疗组（25例）及对照组（25例）。其中对照组行采用全景式硬管镜常规探查后扩宫,行分离粘连治疗;治疗组在对照组的基础上加用医用透明质酸钠凝胶。根据宫腔恢复情况、输卵管通畅情况、月经恢复情况、痛经情况等来评价医用透明质酸钠凝胶应用于人工流产后宫颈粘连的效果及安全性。结果治疗组与对照组比较,除术后经量减少1／3比例比较外,其他差异均有显著统计学意义（P〈0．05）。不良反应情况的结果显示,治疗组无再次粘连的发生,对照组出现3例再次粘连的情况,差异有统计学意义（P〈0．05）。结论医用透明质酸钠凝胶有预防宫腔粘连、促进愈合、降低再次粘连的发生率等作用,可用于人工流产术宫腔粘连的治疗,安全有效。     

腹膜粘连的预防研究进展(文献综述)

术后腹膜粘连是腹部手术的常见并发症，术前不可预测。本文对其预防研究进展作了介绍，改进外科手术技巧可降低其发生率和严重程度，使用各种辅助治疗是必要的。近期采用的损伤面间置隔离物有较好的防粘连效果。     

Effects of seprafilm on peritoneal fibrinolytic system

BACKGROUND: There is a high incidence of adhesions after ventral hernia repair with polypropylene mesh. The purpose of the present study was to evaluate the efficacy of Seprafilm in the prevention of adhesion formation and effect on peritoneal fibrinolytic activity. METHODS: An incisional hernia model was created in rats. In the experimental group Seprafilm was placed between polypropylene mesh and abdominal organs. On the 14th day adhesions were evaluated and tissue plasminogen activator (tPA), urokinase plasminogen activator (uPA), plasminogen activator inhibitor (PAI) type 1 and 2 were measured in peritoneal biopsy specimens. Results: Adhesions were significantly reduced in the Seprafilm group (P = 0.002). Nevertheless, there were no difference between the two groups in levels of tPA, PAI-1 and PAI-2. However, the levels of uPA were significantly decreased in the Seprafilm group. CONCLUSIONS: The adhesion preventive effect of Seprafilm is not directly related in peritoneal fibrinolytic activity. Instead, the physical properties (barrier, hydroflotation and sliconizing effect) of the membrane are primarily responsible for adhesion prevention.     

The effect of immunosuppression on peritoneal adhesions formation after small bowel transplantation in rats

BACKGROUND: The reported incidence of adhesion related small bowel obstruction after abdominal organ transplantation is considerably lower than other abdominal procedures. The purpose of the study was to investigate the influence of immunosuppression on peritoneal adhesion formation after intestinal transplantation in rats. METHODS: Four groups of rats (n = 6) underwent small bowel intestinal transplantation in syngeneic (Groups A, B) and allogeneic (Groups C, D) combinations. Groups B and D received tacrolimus immunosuppression 1 mg/kg/d. Animals were euthanized on postoperative day 7, and the total adhesion score (TAS), tissue hydroxyproline content (HPC), TGF-beta mRNA expression levels and histology were examined. RESULTS: All of the animals in Group C showed severe histological (Grade III) acute cellular rejection. There were no histological signs of rejection in Group D. A significant reduction in TAS was observed in tacrolimus treated animals in both syngeneic and allogeneic combinations (Groups B and D), compared with controls (Groups A and C) (P < 0.001 and P < 0.01, respectively). TAS results correlated with the differences in TGF-beta levels that showed significant reduction when each immunosuppressed group was compared with its nontreated counterpart, i.e., (Groups B versus A, P < 0.05, and Groups D versus C, P < 0.01). TGF-beta levels were significantly high in the rejection group (C) and correlated with the intense adhesion formation that was demonstrated in that group. Group C was also the only group in which a significant elevation in HPC was demonstrated (P < 0.001). CONCLUSION: Intense adhesion formation occurs during early posttransplant acute rejection. Postsurgical adhesion formation is significantly reduced in immunosuppressed rats after intestinal transplantation.     

Prevention of peritoneal adhesions in rats with trimetazidine

The effect of trimetazidine (an antianginal drug that acts as a scavenger of oxygen radicals) in the prevention of peritoneal adhesions induced by complete vascular obstruction of an ileal segment for 30 minutes followed by reperfusion was investigated in rats. Group A (n = 20) acted as controls. Group B (n = 20) received trimetazidine intravenously in a dose of 2.5 mg/kg 30 minutes before the induction of ischaemia. Group C (n = 20) received the same dose of trimetazidine for 5 days before the experiment, twice a day intraperitoneally, and also intravenously 30 minutes before the induction of ischaemia. Group D (n = 20) received the same dose of trimetazidine intravenously immediately after reperfusion had started. Ten days later adhesions had developed in 90% of the animals of group A, 40% of those in group B (p less than 0.001), 5% of those in group C (p less than 0.001), and 60% of those in group D (p less than 0.05). The severity of adhesions was significantly less in the treated groups than in the control animals. Release of creatine phosphokinase during ischaemia and reperfusion significantly increase in groups A, B, and D. These results suggest that trimetazidine reduces the incidence and severity of peritoneal adhesion formation induced by ileal ischaemia and reperfusion, treatment before induction of ischaemia gave better results than treatment given afterwards.     

硒化壳聚糖促创面愈合作用的初步研究

目的：通过研究硒化壳聚糖对体外培养皮肤成纤维细胞增殖的影响来评判其对创面愈合的作用。方法：用不同剂量（25mg/L、50mg/L、100mg/L、200mg/L、400mg/L）硒化壳聚糖作用于成纤维细胞,光镜下观察药物对细胞形态的影响;MTT法、3H-TdR、3H-脯氨酸掺入法、细胞生长动力学研究用于检测药物对细胞增殖及胶原合成影响;LDH漏出率用于检测药物对细胞有无损伤;并以等体积细胞培养液处理为对照组。结果：各浓度药物处理细胞后,细胞形态未见明显改变,均可使细胞吸光度值增加,细胞倍增时间缩短,促进细胞对3H-TdR和3H-脯氨酸的掺入（P〈0.05,P〈0.01）,降低LDH漏出率（P〈0.05,P〈0.01）。结论：硒化壳聚糖可促进体外培养皮肤成纤维细胞增殖和胶原合成,进而促进创面愈合。     

Morphology, quality, and composition in mature human peritoneal adhesions

Background and aim Peritoneal adhesions are caused by intra-abdominal surgery and can lead to relevant complications. Adhesions are supposed to consist of avascular scar tissue. The aim of the present study was to analyze whether mature postsurgical adhesions even after years still reveal a dynamic remodeling process. Materials and methods In a prospective analysis, we investigated tissue specimen of peritoneal adhesions in 40 patients after abdominal surgery. Expression of five parameters representing wound healing and remodeling were examined (MMP-2, Ki-67, apoptosis, collagen/protein ratio, and collagen type I/III ratio). Results Gender, age, and the number of previous operations had no impact on the parameters measured. Adhesion specimens were cell rich, containing mononuclear round cells, fibroblasts, adipose cells, and vascular endothelial cells. There was a positive expression of MMP-2 and apoptosis, whereas Ki-67 was marginal irrespective of adhesion maturity or quality. Adhesions classified as dense showed a significant increase in total collagen (118.2 ± 4.9 μg/mg) and collagen type I/III ratios (3.9 ± 0.2), whereas there were no significant differences regarding the adhesion maturity. Conclusion The distinct composition of cellular components as well as of extracellular matrix proteins may reflect an interactive cross-talk between adhesion- and stroma-derived cells even in mature adhesions. Our findings support the hypothesis that the disabilities of appropriate repair of the peritoneal surface leading to persistent adhesions are a consequence of a permanent process of disturbed remodeling.     

Sepramesh and postoperative peritoneal adhesions in a rat model

Purpose: The present study aimed to investigate the safety and the anti-postoperative peritoneal adhesion (PPA) characteristics of Sepramesh^® (Davol), a composite mesh made of polypropylene covered with Seprafilm, when intraperitoneally placed in a rat model.

Methods: Twenty male rats were randomized into a control group and a Sepramesh group. They underwent a primary surgical procedure aiming to induce a peritoneal injury in order to induce PPAs. In the Sepramesh group, the burnt peritoneum was covered with a 2-cm diameter disc of Sepramesh prosthesis. The mesh was fixed to the parietal peritoneum with four 3-0 absorbable stitches. PPAs were assessed during a second laparotomy 10 days later using quantitative and qualitative scoring systems.

Results: There was no difference in terms of mean number of PPAs between both groups. All the rats from the control group developed PPAs. In the Sepramesh group, no adhesions were observed at the site of the injured peritoneum that had been covered with the Sepramesh prosthesis, but PPAs occurred at the extremities of the mesh, where there was close contact between polypropylene and viscera, or where the fixation sutures were placed. The severity and the type of adhesions were significantly higher in the control group.

Conclusions: This study demonstrated that for the Sepramesh prostheses, the Seprafilm layer might be effective in PPA prevention, but damage caused by the section and fixation of Sepramesh should be limited in order to limit PPAs.     

几丁糖改性膜预防椎板切除术后硬膜外粘连

目的　探讨预防椎板切除术后硬膜外粘连的有效材料和方法。方法　新西兰兔 2 4只 ,行L2 、L4及L6椎板切除术 ,造成 8mm× 5mm硬脊膜裸露区 ,共 72个节段 ,随机分为 3组 ,分别植入不同的材料 :A组植入几丁糖改性膜 ;B组植入透明质酸钠 ;C组用生理盐水对照。术后 2、4、8、12周处死动物取材 ,进行瘢痕形成情况的肉眼观察和组织学观察、硬膜外粘连等级评定及图像分析等。结果　C组硬膜外形成致密粘连 ,B组部分粘连 ,A组无明显粘连。结论　几丁糖改性膜对硬膜外粘连有明显的预防作用 ,其作为椎板切除术后的内植物值得做进一步研究