Avsar Ayse Filiz, Avsar Fatih Mehmet, Sahin Mustafa, Topaloglu Serdar, Vatansev Husamettin, Belviranli Metin
Department of Obstetrics and Gynecology, Zekai Tahir Burak Maternity Training and Research Hospital, Ankara, Turkey.
Eur J Obstet Gynecol Reprod Biol. 2003 Jan 10;106(1):50-4. doi: 10.1016/s0301-2115(02)00213-0.
The purpose of this study is to investigate the effects of diphenhydramine-HCl and Na-hyaluronate derivatives on the development of postoperative peritoneal adhesion and tubal obstruction.
Forty female rats of Sprague-Dawley type were used in the study. The rats were divided into four groups, each comprising 10 subjects. After all the rats were anaesthetized with 50mg/kg ketamine HCl, their abdomens were opened with a lower midline incision. Injury was induced on the right pelvic peritoneum and on the peritoneal surface of left uterine tube. No additional procedure was applied to the first group. 10 mg/kg diphenhydramine-HCl was given to the second group intravenously. In the third group, 0.25 mg/kg Orthovisc, a Na-hyaluronate derivative was diluted with 2 ml physiological saline and poured into the abdomen. For the fourth group, Seprafilm, a Na-hyaluronate derivative was covered in a layer of 0.7 cm x 3 cm over the left uterine tube. After 14 days, the rats were anaesthetized with ketamine HCl again, and 5 cm(3) blood sample was taken with cardiac puncture. The abdomen was opened with an incision transverse to the upper end of the midline incision, and the presence of adhesions was investigated. Detected adhesions were staged according to the Mazuji classification. Tubal patencies were inspected by injecting methylene blue from the uterine corpus into the lumen using an injector. A piece of abdominal wall of 4 cm x 4 cm was removed by extending the incision in the reverse U shape. The tensile strength and bursting pressure of the suture line were determined using the Peacock method. One gram of tissue was taken from the incision line, and hydroxyproline levels were determined by the Bergman-Loxley method. Aspartate aminotransferase (AST) levels were measured.
All of the rats completed the study. AST levels, tissue hydroxyproline levels and tensile strength and bursting pressure test results were found to be similar in all groups. While adhesion rates in the groups were 100, 40, 40 and 30%, respectively, adhesion stages were found to be, respectively as 2.1+/-1.7, 0.6+/-0.67, 0.6+/-0.67 and 0.5+/-0.85. Adhesion stages in the study groups were significantly lower (P<0.05). Tubal obstruction rates were found to be 70, 30, 30 and 20%, respectively.
Diphenhydramine, Orthovisc and Seprafilm significantly reduce postoperative peritoneal adhesion development, and they allow the uterine tubes to remain open.
本研究旨在探讨盐酸苯海拉明和透明质酸钠衍生物对术后腹膜粘连和输卵管阻塞形成的影响。
本研究使用了40只Sprague-Dawley品系的雌性大鼠。将大鼠分为四组，每组10只。所有大鼠用50mg/kg盐酸氯胺酮麻醉后，经下腹正中切口打开腹腔。在右盆腔腹膜和左输卵管腹膜表面造成损伤。第一组不进行额外处理。第二组静脉注射10mg/kg盐酸苯海拉明。第三组，将0.25mg/kg的透明质酸钠衍生物Orthovisc用2ml生理盐水稀释后注入腹腔。第四组，将透明质酸钠衍生物Seprafilm覆盖在左输卵管上，覆盖面积为0.7cm×3cm。14天后，再次用盐酸氯胺酮麻醉大鼠，通过心脏穿刺采集5cm³血样。沿中线切口上端横向切开腹壁，检查粘连情况。根据Mazuji分类法对检测到的粘连进行分期。通过用注射器从子宫体向管腔内注入亚甲蓝来检查输卵管通畅情况。将切口呈倒U形延长，切除一块4cm×4cm的腹壁。采用Peacock法测定缝线的抗张强度和破裂压力。从切口处取1g组织，采用Bergman-Loxley法测定羟脯氨酸水平。测定天冬氨酸转氨酶（AST）水平。
所有大鼠均完成研究。发现所有组的AST水平、组织羟脯氨酸水平以及抗张强度和破裂压力测试结果相似。各组的粘连率分别为100%、40%、40%和30%，粘连分期分别为2.1±1.7、0.6±0.67、0.6±0.67和0.5±0.85。研究组的粘连分期显著更低（P<0.05）。输卵管阻塞率分别为70%、30%、30%和20%。
盐酸苯海拉明、Orthovisc和Seprafilm可显著减少术后腹膜粘连的形成，并使输卵管保持通畅。
