羧甲基壳聚糖预防兔手术后粘连的效果:大体和病理学大样本观察

  目的  评价羧甲基壳聚糖(N, O-carboxymethyl chitosan, NOCC)预防兔手术后粘连的效果。  方法  220只雌性大耳白兔采用双子宫模型造成手术粘连, 随机分组后接受单纯造模手术(对照组)或造模手术+关腹前腹腔内注射NOCC(NOCC组)。所有手术均由同一位术者完成。每组各22只大耳白兔在实验设计的5个观察时间点(术后3、7、14、28和42 d)分别被处死并评估其粘连情况, 包括范围、类型和强度等大体情况和炎症、纤维化以及新生血管等镜下情况。  结果  NOCC组在术后3 d时其粘连的范围(P=0.0337)和强度(P=0.0271)以及炎症反应情况(P < 0.0001)均显著轻于对照组。在术后14 d内, NOCC组的纤维化情况均明显轻于对照组(P均 < 0.0005)。与对照组相比, NOCC组的粘连强度在术后14、28、42 d均明显减轻(P均 < 0.05), 而其粘连类型评分在术后28和42 d也明显降低(P均 < 0.05)。  结论  经NOCC处理后, 兔盆腹腔术后粘连大体和病理学评分均不同程度降低。应用NOCC可有效预防盆腹腔术后粘连。

Prevention of Postoperative Adhesions with N,O-carboxymethyl Chitosan in Rabbit: A Large-sample Gross and Histopathological Observation

  Objective  To assess the effect of N, O-carboxymethyl chitosan (NOCC) in preventing postoperative adhesion in a rabbit model.  Methods  Double uterine horn model was established in 220 female rabbits to induce postoperative adhesion. The rabbits were randomized to receive either adhesion-inducing operation only (control group) or adhesion-inducing operation + intraperitoneal injection of NOCC before closure (NOCC group). All the operations were performed by one operator. Twenty-two rabbits from each group were euthanized at one of the five different time points (postoperative day 3, 7, 14, 28, and 42), and adhesion formation was scored both grossly (extent, type, and tenacity) and histopathologically (inflammation, fibrosis, and vascularization).  Results  The extent (P=0.0337) and tenacity of adhesion (P=0.0271) as well as inflammation(P < 0.0001) were lower in the NOCC group than in the control group on day 3. Fibrosis was less obvious in the NOCC group compared to the control group (P < 0.0005) before day 14. The tenacity scores of adhesion on day 14, 28, and 42 were significantly lower in the NOCC group than in the control group(all P < 0.05), while the type scores were obviously lower in the NOCC group on day 28 and 42(all P < 0.05).  Conclusions  Treatment with NOCC could reduce both gross and histopathological scores of surgery-induced abdominopelvic adhesions in rabbits. NOCC could be an effective therapy for preventing postoperative abdominopelvic adhesion.