Lardinois D, Vogt P, Yang L, Hegyi I, Baslam M, Weder W
Division of Thoracic Surgery, University Hospital, Zurich, Switzerland.
Eur J Cardiothorac Surg. 2004 May;25(5):865-71. doi: 10.1016/j.ejcts.2004.01.028.
Non-steroidal anti-inflammatory drugs (NSAIDs) are often applied for pain management after thoracic surgery. Since these drugs diminish collagen deposition through inhibition of the prostaglandin synthesis, we investigated their effects on adhesion formation after endoscopic mechanical pleural abrasion, which is often applied in the therapy of pneumothorax.
Mechanical pleural abrasion was performed unilaterally by the use of video-assisted thoracoscopic surgery technique in an established pig model. Ten animals (41.3+/-3.4 kg) were divided into a treatment group and a control group. In the treatment group, animals received 100 mg diclofenac (2 mg/kg body weight) orally daily for 3 weeks after surgery. At 3 weeks, all animals were sacrificed and efficacy of pleurodesis was macroscopically assessed by three independent reviewers blinded to the treatment of animals using a five-point severity pleurodesis score (from 0, no adhesions to 4, complete symphisis) and obliteration grade rating the distribution of adhesions (from 0, no adhesions to 4, adhesions in the whole chest). Microscopic evaluation was performed by two pathologists blinded to the study groups as well. A four-point score assessed the amount of collagen deposition (from 1, a few collagen fibers to 4, scar).
Gross observation showed more dense adhesions in control animals with a median pleurodesis score of 3.67+/-1.0 in comparison to 2+/-2.2 in the treatment group (P = 0.01 *, Mann-Whitney non-parametric test). Distribution of adhesions was comparable in both groups with a median obliteration score of 3.67+/-1.3. Histopathologic examination showed a higher amount of collagen deposition in the control group, suggesting more dense adhesions, whereas in the treatment group there was loose granulation tissue (score of 4.0+/-0.8 vs. 2.3+/-1.0 in the treatment group, P = 0.06). The degree of inflammatory reaction was comparable in the two groups.
Our results demonstrate that perioperative use of NSAIDs highly affects the quality of pleural adhesions obtained after mechanical abrasion in this pig model, which further suggests that these drugs should be avoided for pain management when a pleurodesis is performed.
非甾体抗炎药（NSAIDs）常用于胸外科手术后的疼痛管理。由于这些药物通过抑制前列腺素合成减少胶原蛋白沉积，我们研究了它们在内镜下机械性胸膜摩擦术后对粘连形成的影响，这种手术常用于气胸治疗。
在已建立的猪模型中，使用电视辅助胸腔镜手术技术单侧进行机械性胸膜摩擦。10只动物（41.3±3.4千克）分为治疗组和对照组。治疗组动物在术后3周内每天口服100毫克双氯芬酸（2毫克/千克体重）。3周时，处死所有动物，由三名对动物治疗情况不知情的独立评估者使用五点胸膜固定严重程度评分（从0，无粘连到4，完全融合）和粘连闭塞分级（从0，无粘连到4，全胸粘连）对胸膜固定效果进行宏观评估。两名对研究组不知情的病理学家也进行了微观评估。用四分制评分评估胶原蛋白沉积量（从1，少量胶原纤维到4，瘢痕）。
大体观察显示，对照组动物的粘连更致密，胸膜固定评分中位数为3.67±1.0，而治疗组为2±2.2（P = 0.01*，曼-惠特尼非参数检验）。两组粘连分布相当，闭塞评分中位数为3.67±1.3。组织病理学检查显示对照组胶原蛋白沉积量更高，表明粘连更致密，而治疗组为疏松肉芽组织（治疗组评分为4.0±0.8，对照组为2.3±1.0，P = 0.06）。两组炎症反应程度相当。
我们的结果表明，在该猪模型中，围手术期使用NSAIDs对机械摩擦后获得的胸膜粘连质量有很大影响，这进一步表明，在进行胸膜固定术时，应避免使用这些药物进行疼痛管理。
