Bowers D, Raybon R B, Wheeless C R
Institute for Special Pelvic Surgery, Department of Obstetrics and Gynecology, Sinai Hospital of Baltimore, Maryland 21215, USA.
Am J Obstet Gynecol. 1999 Dec;181(6):1335-7; discussion 1137-8. doi: 10.1016/s0002-9378(99)70373-x.
Postoperative intra-abdominal adhesions are a major source of postsurgical morbidity. Pelvic irradiation increases the likelihood of adhesion development. The purpose of this study was to evaluate the effects of hyaluronic acid-carboxymethylcellulose film, which was designed as a barrier to prevent adhesions, on the healing of ileal anastomoses performed on irradiated rat bowel.
Sixty-eight female Sprague-Dawley rats underwent whole pelvic irradiation with a single fraction of 1700 cGy. Twenty weeks later the rats underwent exploratory laparotomy with segmental ileal resection and reanastomosis. Eighteen of the anastomoses were wrapped in hyaluronic acid-carboxymethylcellulose film. Fifty anastomoses were not treated with any adhesion-inhibiting barrier. On the fifth postoperative day the animals underwent another laparotomy for evaluation of the anastomotic sites.
At the second laparotomy 93% of the rats treated with hyaluronic acid-carboxymethylcellulose film were found to have perianastomotic abscesses. In the non-hyaluronic acid-carboxymethylcellulose film group the perianastomotic abscess rate was 24% (P <.0001).
Among previously irradiated rats undergoing small-bowel resection and anastomosis, hyaluronic acid-carboxymethylcellulose film was associated with a markedly increased rate of abscess formation at the operative site.
术后腹腔粘连是术后发病的主要原因。盆腔放疗会增加粘连形成的可能性。本研究的目的是评估设计用于防止粘连的透明质酸-羧甲基纤维素膜对接受放疗的大鼠肠段进行回肠吻合口愈合的影响。
68只雌性Sprague-Dawley大鼠接受单次1700 cGy的全盆腔照射。20周后，大鼠接受剖腹探查术，进行节段性回肠切除和再吻合。其中18个吻合口用透明质酸-羧甲基纤维素膜包裹。50个吻合口未使用任何粘连抑制屏障进行处理。术后第5天，动物再次接受剖腹手术以评估吻合部位。
在第二次剖腹手术中，发现93%接受透明质酸-羧甲基纤维素膜治疗的大鼠有吻合口周围脓肿。在非透明质酸-羧甲基纤维素膜组中，吻合口周围脓肿发生率为24%（P<.0001）。
在先前接受放疗的大鼠进行小肠切除和吻合术中，透明质酸-羧甲基纤维素膜与手术部位脓肿形成率显著增加有关。
