Alimoglu Orhan, Akcakaya Adem, Sahin Mustafa, Unlu Yasar, Ozkan Orhan V, Sanli Erdal, Eryilmaz Ramazan
First Department of Surgery, Vakif Gureba Training Hospital, Istanbul, Turkey.
Hepatogastroenterology. 2003 May-Jun;50(51):725-8.
BACKGROUND/AIMS: Adhesion formation after abdominal surgery or incisional hernia repair with prosthetic materials may cause chronic pain, intestinal obstruction, enterocutaneous fistulae, difficulty in reoperative procedures and infertility in females. The aim of this study was to compare different modalities in terms of adhesion prevention in a rat model of abdominal wall defect repaired with prosthetic materials.
Forty-eight female Wistar-Albino rats were divided into four groups. In all rats, laparotomy was performed through a 3-cm midline incision and an abdominal wall defect (2 x 3 cm) was created in rats in groups II, III and IV. Following procedures were performed in all rats: seroza of the cecum was abraded and sutured with 4-0 silk and two ischemic buttons were created by ligating with 4-0 silk on the left and right sides of abdominal parietal peritoneum. In Group I, abdominal closure was obtained with a running 4-0 prolene suture. In Group II, abdominal wall defect was repaired with polypropylene mesh. In Group III, Seprafilm, an absorbable adhesion barrier, was laid over the abdominal viscera and defect was repaired with polypropylene mesh. In Group IV, defect was repaired with Composix mesh. Adhesion density score, adhered organ and strength of mesh incorporation were evaluated. Biochemical analysis and histopathological examination were performed.
Groups II and III had more adhesion density scores than groups I and IV, (P < 0.001). Group II had more cecal and ischemic button adhesions than groups I, III and IV, (P < 0.001). Strength of mesh incorporation was higher in groups II and III than group IV, (P < 0.001). Abscess formation was more common in group IV than those in groups II and III, (P < 0.001). There were no differences between groups, regarding serum levels of C-reactive protein and fibrinogen. The most common adhered organ was omentum.
There is no single treatment modality to prevent adhesion formation after abdominal wall defect repaired with prosthetic materials. While intraperitoneal adhesions were less common in Seprafilm group, adhesions to mesh were less common in the Composix mesh group.
背景/目的：腹部手术后或使用人工材料进行切口疝修补术后形成的粘连可能导致慢性疼痛、肠梗阻、肠皮肤瘘、再次手术困难以及女性不孕。本研究的目的是在使用人工材料修复腹壁缺损的大鼠模型中，比较不同预防粘连方法的效果。
将48只雌性Wistar - Albino大鼠分为四组。所有大鼠均通过3厘米的中线切口进行剖腹手术，第二、三、四组大鼠制造腹壁缺损（2×3厘米）。所有大鼠均进行以下操作：将盲肠浆膜擦伤并用4-0丝线缝合，在腹侧壁腹膜的左右两侧用4-0丝线结扎形成两个缺血纽扣。第一组用连续4-0聚丙烯缝线关闭腹腔。第二组用聚丙烯网片修复腹壁缺损。第三组在腹腔脏器上覆盖可吸收粘连屏障Seprafilm，并用聚丙烯网片修复缺损。第四组用Composix网片修复缺损。评估粘连密度评分、粘连器官及网片植入强度。进行生化分析和组织病理学检查。
第二组和第三组的粘连密度评分高于第一组和第四组（P < 0.001）。第二组的盲肠和缺血纽扣粘连比第一、三、四组更多（P < 0.001）。第二组和第三组网片植入强度高于第四组（P < 0.001）。第四组脓肿形成比第二组和第三组更常见（P < 0.001）。各组之间C反应蛋白和纤维蛋白原血清水平无差异。最常见的粘连器官是大网膜。
对于使用人工材料修复腹壁缺损后预防粘连形成，没有单一的治疗方法。虽然Seprafilm组腹腔内粘连较少见，但Composix网片组与网片的粘连较少见。
