Ghellai A M, Stucchi A F, Lynch D J, Skinner K C, Colt M J, Becker J M
Department of Surgery, Boston University School of Medicine, MA 02118, USA.
J Gastrointest Surg. 2000 May-Jun;4(3):310-5. doi: 10.1016/s1091-255x(00)80081-5.
Adhesions remain a significant postoperative complication of abdominal surgery; however, recent evidence suggests that physical barriers may reduce their incidence. Although these adhesion prevention barriers are efficacious when used under aseptic conditions, little is known about their use in the presence of peritonitis, which is associated with an increased incidence of abdominal adhesions. A sodium hyaluronate and carboxymethylcellulose bioresorbable membrane (HA membrane) has been shown recently to reduce postoperative adhesions in several animal models and in two clinical trials. To investigate the efficacy of HA membrane in the presence of peritonitis, generalized peritonitis was induced in rats by either cecal ligation and puncture (CLP) or cecal ligation (CL) alone. The ceca were resected after 12 hours, and animals were randomly assigned to receive or not receive HA membrane applied to the cecum. At day 7, abdominal adhesions and abscesses were scored. In the presence of peritonitis, HA membrane did not significantly reduce the number or tenacity of adhesions. A trend toward increased abscess formation was associated with HA membrane in the CL group. Although HA membrane has been shown to reduce the incidence and severity of abdominal adhesions under aseptic conditions, this study demonstrates that it is not efficacious in preventing abdominal adhesions in the presence of peritonitis. The association between HA membrane and abscess formation in the presence of experimental peritonitis requires further investigation.
粘连仍然是腹部手术的一种重要术后并发症；然而，最近的证据表明物理屏障可能会降低其发生率。尽管这些粘连预防屏障在无菌条件下使用时是有效的，但对于它们在腹膜炎情况下的使用知之甚少，而腹膜炎与腹部粘连发生率的增加有关。最近，一种透明质酸钠和羧甲基纤维素可生物吸收膜（HA膜）已在多个动物模型和两项临床试验中显示出可减少术后粘连。为了研究HA膜在腹膜炎情况下的疗效，通过盲肠结扎和穿刺（CLP）或仅盲肠结扎（CL）在大鼠中诱发全身性腹膜炎。12小时后切除盲肠，并将动物随机分配接受或不接受应用于盲肠的HA膜。在第7天，对腹部粘连和脓肿进行评分。在存在腹膜炎的情况下，HA膜并未显著减少粘连的数量或强度。在CL组中，HA膜与脓肿形成增加的趋势有关。尽管HA膜已被证明在无菌条件下可降低腹部粘连的发生率和严重程度，但本研究表明它在腹膜炎存在时预防腹部粘连并不有效。在实验性腹膜炎情况下，HA膜与脓肿形成之间的关联需要进一步研究。
