Moreira H, Wexner S D, Yamaguchi T, Pikarsky A J, Choi J S, Weiss E G, Nogueras J J, Sardinha T C, Billotti V L
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.
Dis Colon Rectum. 2000 Feb;43(2):182-7. doi: 10.1007/BF02236979.
Patients in whom enterolysis is performed are at high risk for recurrence of adhesions and for injury during adhesiolysis. Therefore, the aim of this study was to assess the safety of sodium hyaluronate-based bioresorbable membrane (Seprafilm) after myotomy and enterotomy.
A total of 60 rabbits underwent laparotomy with equal distribution to one of three groups: creation of either three repaired, or three unrepaired myotomies, or three repaired enterotomies. Thus, a total of 180 defects were created in the same anatomic positions. One-half of the animals in each group had the surface of the myotomies or enterotomies covered by Seprafilm. Fourteen days later, after complete absorption of Seprafilm, the presence of intra-abdominal abscess, adhesions, and the integrity of the suture line were evaluated by a surgeon blinded to the use of Seprafilm and by a standard radiographic isobaric contrast study. Statistical analysis was done by use of Fisher's exact test; significance was set at P < 0.05.
The incidence of adhesions in the repaired myotomy group were 2 (6.6 percent) and 9 (30 percent) in the Seprafilm and control (nonSeprafilm) groups, respectively (P < 0.05); in the unrepaired myotomy group, 2 (6.6 percent) and 10 (33 percent) in the Seprafilm and control groups, respectively (P < 0.05); and in the enterotomy group, 28 (94 percent) and 29 (97 percent) in the Seprafilm and control groups, respectively (P = not significant). A single phlegmon occurred in the myotomy group at a Seprafilm site (1.6 (1/60) vs. 0 percent, P = not significant). There were no leaks in this group. In the enterotomy group, the incidence of phlegmons was 33 percent (10/30) in the Seprafilm group, whereas it was 27 percent (8/30) in the nonSeprafilm group (P = not significant). The incidence of leaks was 6.6 (2/30) and 10 percent (3/30) in the Seprafilm and nonSeprafilm group, respectively (P = not significant).
The use of Seprafilm at the sites of myotomies significantly reduced the incidence of adhesions. Effectiveness at the enterotomy site may have been attenuated by a greater inflammatory response. Importantly, Seprafilm did not increase septic mortality in any group.
接受肠粘连松解术的患者发生粘连复发及粘连松解术期间损伤的风险较高。因此，本研究旨在评估基于透明质酸钠的生物可吸收膜（Seprafilm）在肌切开术和肠切开术后的安全性。
总共60只兔子接受剖腹手术，平均分为三组中的一组：分别进行三处修复或三处未修复的肌切开术，或三处修复的肠切开术。因此，在相同解剖位置总共制造了180个缺损。每组动物中有一半的肌切开术或肠切开术表面覆盖有Seprafilm。14天后，在Seprafilm完全吸收后，由对Seprafilm使用情况不知情的外科医生通过标准的放射学等压造影研究评估腹腔内脓肿、粘连的存在情况以及缝线的完整性。采用Fisher精确检验进行统计分析；显著性设定为P<0.05。
修复肌切开术组中，Seprafilm组和对照组（非Seprafilm组）粘连的发生率分别为2例（6.6%）和9例（30%）（P<0.05）；未修复肌切开术组中，Seprafilm组和对照组分别为2例（6.6%）和10例（33%）（P<0.05）；肠切开术组中，Seprafilm组和对照组分别为28例（94%）和29例（97%）（P无显著性差异）。在肌切开术组的一个Seprafilm部位出现了一处蜂窝织炎（1.6%（1/60）对0%，P无显著性差异）。该组无渗漏情况。在肠切开术组中，Seprafilm组蜂窝织炎的发生率为33%（10/30），而非Seprafilm组为27%（8/30）（P无显著性差异）。Seprafilm组和非Seprafilm组渗漏的发生率分别为6.6%（2/30）和10%（3/30）（P无显著性差异）。
在肌切开术部位使用Seprafilm可显著降低粘连的发生率。在肠切开术部位的有效性可能因更强的炎症反应而减弱。重要的是，Seprafilm在任何组中均未增加感染性死亡率。
