电针足三里穴减轻大鼠术后腹腔粘连的实验研究

目的：观察电针刺激足三里穴对大鼠术后腹腔粘连的预防作用。方法：44只雄性Wistar大鼠随机分为假手术组（n=12）、腹腔粘连组（n=16）、电针足三里组（n=16）。采用开腹后无菌干纱布摩擦大鼠盲肠蚓突盲端,继之损伤侧腹壁法制作大鼠腹腔粘连动物模型。各组于术后7d和14d各处死一半动物,参考Phillips五级分类法评估腹腔粘连程度并计分。取粘连组织切片,分别行苏木素-伊红（HE）染色观察粘连组织病理学变化及免疫组化染色观察粘连组织I型胶原含量变化,并进行图像分析。结果：电针足三里组腹腔粘连组织面积明显减少,7d与14d大体粘连评分均明显低于腹腔粘连组（P〈0.01）。HE染色显示,与腹腔粘连组比较,电针足三里组炎症反应轻,增生纤维结缔组织少;I型胶原免疫组化染色结果显示,电针足三里组累积吸光度值（29211±21334）显著低于腹腔粘连组（124189±48314）,差异有显著性（P〈0.01）。结论：电针刺激大鼠足三里穴可显著减轻大鼠腹腔粘连形成。     

羧氨基萄聚多糖钠间断腹腔内注射预防术后腹腔粘连

目的探讨羧氨基萄聚多糖钠（术尔泰）间断腹腔注射预防术后腹腔粘连。方法32只雌性SD大鼠完全随机法均分为四组：A组为假手术组、B组为术尔泰一次性腹腔灌注组、C组为术尔泰问断腹腔注射组、D组为生理盐水处理组。A组行开关腹手术,B、C、D三组制作腹腔粘连模型,10d后处死动物,行BellucoC粘连评分;行HE和Masson染色,sP法观察粘连组织转化生长因子-β1（TGF-β1）的表达。结果①A组粘连最轻,C组粘连评分明显低于D组和B组。②HE、Masoon染色示A组无明显炎症反应,C组较B、D两组的炎症反应明显减轻。③A组与C组TGF-β1的表达无明显差异,但两组TGF-β1的表达要明显轻于D组和B组,差异有统计学意义（P〈0．01）。结论术后腹腔间断注入羧氨基萄聚多糖钠可以显著抑制TGF-β1表达,其防粘连作用明显优于一次性腹腔灌注。     

腹腔内置疝修补补片动物实验的病理评价

目的以满足《腹腔内置疝修补补片动物实验技术审查指导原则》要求为基础，探讨客观、准确的病理检测指标和评价方法。 方法选取两种复合疝修补补片，分别植入犬腹腔内左右两侧腹壁。12周后将补片植入区域连同周围正常组织取材，采用免疫组织化学及免疫荧光染色方法评价新生腹膜比例、炎性反应；采用Masson染色方法检测纤维化程度；采用HE染色方法检测新生血管和脂肪浸润情况。 结果（1）Cytokeratin和Vimentin两种抗体均可以对间皮细胞进行识别，有助于对新生腹膜层长度的测量，Cytokeratin特异性更高；（2）应用抗体CD20、CD3和CD68免疫组化染色可以高效地检测出组织中B淋巴细胞、T淋巴细胞和巨噬细胞，辅助细胞计数和炎性反应评分；（3）CD34免疫组化染色观察新生血管情况并计算新生血管密度；（4）HE染色可以直接观察脂肪细胞浸润情况并进行半定量评分；（5）Masson染色可以清晰直观地反应胶原纤维沉积情况，对纤维沉积区域厚度进行测量、比较有辅助作用；（6）2组补片的所有观察指标通过定量和半定量方法进行描述，随后进行统计分析，结果显示所有指标间均无统计学差异（P>0.05）。 结论本研究采用的检测方法能对补片植入后的局部反应相关指标进行直接、准确的定位和量化，基本满足《腹腔内置疝修补补片动物实验技术审查指导原则》的要求，对今后开展相关实验具有一定的参考价值。     

卡巴胆碱预防术后腹腔粘连的实验研究

目的 观察拟胆碱药卡巴胆碱预防腹腔粘连的作用。方法 44只雄性Wistar大鼠按完全随机法分为假手术组（n=12）、手术对照组（n=16）及卡巴胆碱组（n=16，卡巴胆碱50ug／kg），后2组采用开腹后无菌干纱布摩擦大鼠盲肠蚓突部，钳夹和刮伤腹壁法制作大鼠腹腔粘连动物模型。各组于术后第7d和第14d各处死一半动物，参考Phillips 5级分类法并结合本模型特点进行大体粘连程度分级评分；取粘连组织切片行HE染色观察粘连组织病理变化，免疫组化法观察粘连组织Ⅰ型胶原含量变化，并进行图像分析。结果 卡巴胆碱组第7d与第14d大体粘连程度评分均明显低于手术对照组，差异有统计学意义（P〈0．01）；HE染色显示卡巴胆碱组比之手术对照组炎症反应轻，偶见增生纤维结缔组织；Ⅰ型胶原含量卡巴胆碱组第7d与第14d均明显低于手术对照组（P〈0．01）；各组内第7d与第14d比较，腹腔大体粘连程度评分和I型胶原含量差异无统计学意义（P〉0．05）。结论 拟胆碱药卡巴胆碱能显著预防大鼠腹腔粘连形成，降低粘连程度。     

腹腔镜胆囊切除致腹腔残留胆石的实验研究

采用兔腹腔内置入胆石的实验，研究腹腔镜胆囊切除时胆石逸出，残留在腹腔，对腹膜，网膜，腹腔内脏器的致病作用，结果发现：腹腔残留胆石可在不同部位形成腹膜、网膜包裹、小肠粘连，肝脏肉芽肿等严重病理改变，提示在ＬＣ时，要严防胆石逸出并残留在腹腔。     

清热解毒方和凉血活血方防治大鼠术后腹腔粘连的组织形态学研究

目的：观察清热解毒方和凉血活血方对大鼠术后腹腔粘连的防治效果并探索其机制。方法：健康雄性 Wistar 大鼠 120 只随机分为 6 组,采用十二指肠钳夹法制作大鼠腹腔粘连模型,分别治疗 7 d 并记录生存情况。术后 14 天时处死剖验并对粘连情况评分,取粘连组织进行 HE 染色和苦味酸 - 天狼星红染色,镜下观察并摄片,对粘连组织纤维化、炎症、血管增殖及Ⅰ、Ⅲ型胶原胶原含量进行评价。结果：4 个治疗组的生存情况与模型组无明显差异（P>0.05）。清热解毒方组术后腹腔粘连范围、强度评分,纤维化评分,血管增殖评分,Ⅰ、Ⅲ型胶原含量均低于其他治疗组（P<0.05）。炎症评分无统计学差异（P>0.05）,结论：清热解毒方、凉血活血方均有良好的抗粘连效果,以清热解毒方为优;抗粘连机理可能与中药的抗炎作用,促进术后肠蠕动恢复,减轻炎症渗出及纤维蛋白基质沉积有关。     

胃癌腹腔微转移检测及其临床意义

摘要：目的 探讨胃癌检测胃癌腹腔微转移的作用及临床意义。方法 选择 50例术前及术中检查均未发现腹膜转移的胃癌病例, 术中行道格拉斯窝处的腹膜活检并行HE常规染色和CK 20免疫组化染色检查，同时用RT PCR方法检测胃癌腹腔冲洗液中CK 20 mRNA的表达。结果 全部患者道格拉斯窝活检腹膜HE染色均为阴性。CK 20免疫组化检查的阳性率为24.0％（12/50）；RT PCR检测腹腔冲洗液中CK 20 mRNA的阳性率为36.0％（18/50）；CK 20免疫组化检查阳性的12例患者腹腔冲洗液中CK 20 mRNA检查均为阳性。CK 20 mRNA阳性率与胃癌浸润深度、组织学类型和淋巴结转移数目有关(P<0.05)。CK 20 mRNA阳性和阴性胃癌患者3年生存率分别为22.2％和62.5％(P<0.01)。结论 术前检查或术中探查未发现腹膜转移的胃癌患者,可行腹腔冲洗液RT PCR检查以发现有无腹腔微转移，该项检查可为胃癌正确分期、腹腔内辅助化疗及预后判断提供证据。     

青霉胺预防术后腹腔粘连的实验研究

目的:观察青霉胺预防腹腔粘连的疗效.方法:将80只昆明小鼠随机分为4组,均于其右侧腹膜固定乳胶片一块,按预先设计分别用青酶胺、几丁糖、透明质酸钠和右旋糖酐进行不同处理后关腹,并给予相应喂养.术后7d,14d剖腹观察粘连情况,对粘连组织行免疫组化染色.结果:4种实验用药对腹腔粘连都有一定的预防作用,3%青霉胺与几丁糖疗效基本相当,作用时间长、效果明显优于透明质酸钠和右旋糖酐,其中右旋糖酐的作用比较差.结论:青霉胺腹腔留置预防腹腔粘连作用持久,效果可靠.     

S-100预防大鼠术后腹腔粘连的实验研究

目的：观察不同浓度S-100防粘连冲洗液预防腹腔粘连的效果及其对血清TGF-β1水平的影响。方法：60只Wistar大鼠随机分为6组,每组10只。包括模型组（A组）、透明质酸钠组（B组）、0.5%S-100组（C组）、3%S-100组（D组）、5%S-100（E组）和泰陵组（F组）。通过粘连分级、HE染色、免疫组织化学染色、羟脯氨酸测定观察S-100预防腹腔粘连效果的同时,测定血清TGF-β1水平。结果：B、C、D、E及F组在粘连分级、HE染色及羟脯氨酸测定方面均优于A组（P〈0.05）;B、C组之间,D、E、F组之间差异无统计学意义（P〉0.05）;D、E、F3组与B、C2组比较差异有统计学意义（P〈0.05）。免疫组织化学染色结果显示B、C、D、E、F组粘连组织内CollagenⅠ含量比A组低（χ2=11.098,P=0.049）。各组大鼠血清TGF-β1水平差异无统计学意义（F=0.161,P=0.976）。结论：S-100防粘连冲洗液具有明显预防腹腔粘连形成的作用,其作用优于透明质酸钠,最佳作用浓度区间为3%～5%。     

医用透明质酸钠预防腹部手术后腹腔粘连的临床观察

目的　观察医用透明质酸钠对预防腹部手术后腹腔粘连的作用。方法 136 0例腹部手术患者 ,关腹前于腹膜及腹腔创面涂抹医用透明质酸钠 (sodiumhyaluronate)凝胶剂 3～ 15ml,随访期间 ,2 3例患者获 2次手术探察的机会 ,观察腹腔粘连程度 ,并与同期未用透明质酸钠凝胶剂的 2 6例 2次手术患者作对比分析。结果观察组 :腹腔粘连Ⅰ级 11例 ,Ⅱ级 9例 ,Ⅲ级 3例 ,Ⅳ级 0例 ;对照组 :Ⅰ级 1例 ,Ⅱ级 5例 ,Ⅲ级 17例 ,Ⅳ级 3例。两组轻度粘连分别为 87%和 2 3% ;两组重度粘连分别为 13%和 77%。两组患者手术后腹腔内粘连情况比较 ,差异有显著意义 (P <0 0 1)。结论透明质酸钠凝胶对腹部手术后预防腹腔粘连具有明显效果。     

Effect of dimethyl sulfoxide and glycerol on acute bowel ischemia in the rat

After a 30 minute period of superior mesenteric artery occlusion in adult rats, there was a significant decrease in peritoneal inflammatory reaction, ileus, peritoneal adhesion formation, and histologically proved bowel wall necrosis in animals given intravenous dimethyl sulfoxide at the end of the ischemic period. In contrast, control rats given normal saline solution intravenously demonstrated severe inflammatory reaction, ileus, hemorrhagic peritoneal fluid, extensive adhesion formation, and areas of bowel wall necrosis. Intravenous glycerol did not have the beneficial effect seen with dimethyl sulfoxide. Neither compound was effective when given intraperitoneally. We conclude that intravenous dimethyl sulfoxide has a significant protective effect in rats with acute intestinal ischemia due to the superior mesenteric artery occlusion in the rat.     

几丁糖对大鼠术后腹腔粘连的预防作用

目的　探讨几丁糖对术后腹腔粘连的预防作用。方法　将 45只大鼠随机分为对照组 (A组 ) ,右旋糖酐组 (B组 ) ,几丁糖组 (C组 ) ,于腹腔内浆膜损伤部位分别注入 1%乳酸液 ,3 2 %右旋糖酐 -70液 ,2 %几丁糖乳酸液各 2ml ,术后 14d处死动物 ,观察各组腹腔粘连状况并送病理检查。结果　 3组粘连分级有显著性差异 (P <0 .0 1) ;C组粘连发生率较另 2组为低 ,有显著性差异 (P <0 .0 5 )。光镜下C组炎症反应轻微 ,纤维增生不明显 ;电镜下C组纤维细胞分泌胶原能力弱 ,间皮细胞增生活跃。结论　几丁糖可有效地降低大鼠术后腹腔粘连的发生和粘连程度 ,其作用优于右旋糖酐 -70 ,且不影响切口的愈合。     

Surgical glove powder and intraperitoneal adhesion formation. An appeal for the use of powder-free surgical gloves.

Intraperitoneal adhesion formation is a major cause of infertility and/or intestinal obstruction. Among the many well-known aetiological factors responsible for peritoneal inflammatory reaction is surgical glove powder; for example, cornstarch powder. A study was undertaken on 30 rats to determine whether cornstarch powder caused intraperitoneal adhesions. The rats were randomised into two groups under laboratory conditions. Laparotomies were performed on all the rats and trauma inflicted to the right uterine horn. The study group received cornstarch powder suspended in normal physiological salt solution intraperitoneally, and the control group received only normal physiological salt solution. Peritoneal adhesions were evaluated after 2 weeks and statistically analysed with a t-test and 95% confidence intervals. The study group showed a statistically significantly higher incidence of intraperitoneal adhesions (P = 0.0003). It is concluded that cornstarch, as used on surgical gloves, caused peritoneal adhesions and should therefore be removed before surgery. Powder-free gloves are more suitable for preventing adhesion formation.     

限制性液体复苏对失血性休克大鼠网状内皮系统的影响

目的探讨限制性液体复苏对失血性休克大鼠网状内皮系统的影响。方法60只SD大鼠制成未控制性重度失血性休克模型,随机分成对照组、NF组(无液体复苏组)、NS40组(限制性液体复苏组)和NS80组(常规大量液体复苏组),检测和比较休克复苏后各组存活大鼠肝脏枯否细胞和腹腔巨噬细胞的吞噬功能。结果重度失血性休克大鼠失血后150min存活率NF组、NS40组和NS80组比对照组明显提高,NS40组较NS80组显著改善(P0.05);NS40组大鼠肝脏枯否细胞和腹腔巨噬细胞的吞噬功能较NS80组明显改善(P0.05)。结论限制性液体复苏可以显著改善失血性休克大鼠的网状内皮系统的吞噬功能,提高大鼠的免疫功能,降低死亡率。     

丹参川芎嗪持续腹腔灌洗对大鼠重症急性胰腺炎的炎症抑制作用

目的探讨丹参川芎嗪持续腹腔灌洗对大鼠重症急性胰腺炎(SAP)的炎症抑制作用。方法 SD雄性大鼠120只,随机分为3组:SAP组、丹参川芎嗪治疗组(T组)、生理盐水治疗组(N组),每组40只。SAP模型由5%牛磺胆酸钠经大鼠胆胰管逆行注射诱发而成。模型成功后,SAP组不做处理;T组和N组置腹腔冲洗管后,经冲洗管分别灌洗丹参川芎嗪、生理盐水。各组于术后(1、2、6、12 h)四个时间经下腔静脉采血5 mL,离心留取血清,ELISA方法检测促炎症因子(IL-1、IL-6、TNF-α)和抗炎症因子(IL-4、IL-10)指标;采血1 mL检测血浆内毒素水平。结果 SAP组血清中促炎症因子TNF-α、IL-1、IL-6水平随病程进展(1、2、6、12 h)而升高,各时间点的SAP组水平明显高于N组、T组(P<0.01);T组水平明显低于N组、SAP组(P<0.01)。N组、T组的抗炎症因子(IL-4、IL-10)水平随病程进展而升高;各时间点的T组水平明显高于N组、SAP组(P<0.01)。各时间点T组血浆内毒素水平显著低于N组、SAP组(P<0.01)。结论丹参川芎嗪持续腹腔灌洗可通过抑制炎性因子的产生,提高抗炎症因子水平,降低细菌内毒素水平,从而起到抑制SAP炎症反应的作用。     

Preventing recurrent postoperative adhesions: an experimental study in rats

A peritoneal lavage model, cyclic intraperitoneal lavage (CIPL), and other adhesion preventing methods with and without fibrinolytic agents were compared to a control group without treatment in an animal study. The adhesion-preventing effect was evaluated at the site of a standardized peritoneal defect (free peritoneal grafting, P) and at the laparotomy wound (L) of 60 rats (12 escape) after surgical lysis of primary adhesions during relaparotomy In five test groups with different treatments and in a control group without treatment recurrent adhesions were investigated during relaparotomy according to an adhesion grading scale with increasing severity (O-III). In the control group only severe adhesions grade II and III were observed. The five test groups showed different distributions of grade 0-II adhesions: compared to the control group a significant difference of the preventing effect was seen after CIPL with 1.36% glucose solution (as used for peritoneal dialysis) and after CIPL with Ringer's solution at the sites P and L, after a one-time irrigation with Ringer's solution only at the peritoneal graft P. Fibrinolytic agents used in CIPL or as single dose application failed to show an improvement compared to the control group.     

Icodextrin reduces postoperative adhesion formation in rats without affecting peritoneal metastasis

BACKGROUND: Peroperative peritoneal trauma activates a cascade of peritoneal defense mechanisms responsible for postoperative adhesion formation. The same cascade seems to play a role in the process of intra-abdominal tumor recurrence. Icodextrin is a glucose polymer solution that is absorbed slowly from the peritoneal cavity, allowing prolonged "hydroflotation" of the viscera, thereby decreasing adhesion formation. This study evaluated the adhesion-preventing properties of icodextrin and its effect on peritoneal metastasis. METHODS: Reproducible rat models of peritoneal trauma were used, allowing semiquantitative scoring of adhesion formation or tumor load. In one experiment, peritoneal trauma was inflicted; one group was treated by peroperative intra-abdominal instillation of 7.5% icodextrin, one by instillation of RPMI (placebo), and one had no instillate (controls). In another experiment involving a different model of peritoneal trauma, the coloncarcinoma cell line CC531 was injected intraperitoneally to induce tumor load, again using these three groups. RESULTS: Treatment of peritoneally traumatized rats with icodextrin caused a 51% reduction in postoperative adhesion formation ( P < .001). However, peroperative intra-abdominal treatment with icodextrin did not affect intraperitoneal tumor cell adhesion and growth of free intra-abdominal tumor cells in rats with this model of severe peritoneal trauma. CONCLUSION: A 7.5% icodextrin solution is effective in reducing postoperative adhesions without promoting tumor recurrence and therefore may prove useful and safe in oncologic surgery.     

小檗碱对严重腹腔感染时肠屏障功能障碍的防治作用

目的探讨小檗碱对严重腹腔感染导致肠屏障功能障碍的防治作用。 方法制备严重腹腔感染大鼠模型即盲肠结扎+穿孔模型（CLP模型）,将90只SD大鼠随机分为感染组（CLP感染,不予治疗）、对照组（只剖腹而不行CLP术）和治疗组（盐酸小檗碱300mg/kg灌胃给药）,各30只,观察各组肠道病理改变,进行血细菌培养,检测血清内毒素、二胺氧化酶（DAO）水平、D-乳酸含量评估其肠屏障功能;同时检测血清C反应蛋白（CRP）、白介素2（IL-2）、肿瘤坏死因子α（TNF-α）水平等炎症相关因子,了解炎症反应情况。 结果治疗组肠黏膜损伤明显减轻;在术后第1、2、4天检测点上,治疗组血清内毒素、DAO及D-乳酸水平明显低于感染组（P<0.01）。同时治疗组TNF-α、血清CRP及IL-2水平明显低于感染组（P<0.01）。 结论严重腹腔感染时过度炎症反应可导致肠屏障功能障碍,小檗碱通过降低炎症反应而实现对肠屏障功能的保护。     

Effects of whole blood, crystalloid, and colloid resuscitation of hemorrhagic shock on renal damage in rats: an ultrastructural study

Purpose:

The aim of this study was to determine the effects of whole blood, crystalloid, and colloid treatment on histopathologic damage of kidney induced by hemorrhagic shock in rats.

Methods:

Fifty-six male Sprague Dawley rats were divided into 8 groups. The carotid artery was cannulated, and systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR), and rectal temperature (RT) were observed during the procedure. The jugular vein also was cannulated, and the SAP was decreased by aspiration of 75% of blood through the jugular vein in the control (nonresuscitated) and study (resuscitated) groups, whereas blood was not diminished in the sham group. The hemorrhagic shock was permitted to last 45 minutes; then, the study group rats were resuscitated with heparinized shed autologous whole blood (WB), normal saline (NS), Lactated Ringer’s solution (LR), hydroxyethyl starch 6% (HES6), hydroxyethyl starch 10% (HES10), or dextran 40 (D40). Histopathologic evaluation was performed under light and electron microscope.

Results:

The RT, SAP, and DAP decreased, and HR increased significantly in the control and study groups during the shock period compared with those of sham group. After volume resuscitation, these parameters changed to preshock levels. Electron and light microscopic examinations of kidneys showed severe proximal tubular degeneration with moderate glomerular damage in the control group; moderate proximal tubular degeneration with mild glomerular damage in the NS, LR, HES6, and HES10 groups; and mild proximal tubular degeneration with no evidence of glomerular damage in the WB and D-40 groups.

Conclusions:

The characteristic ultrastructural features of hemorrhagic shock appear to be severe tubular degeneration and mild to moderate changes in glomeruli. Resuscitation of hemorrhagic shock with whole blood or dextran 40 solution appears to be most favorable therapy in preventing ultrastructural renal damage in rats.