Greenawalt Keith E, Colt M Jude, Corazzini Rubina L, Syrkina Olga L, Jozefiak Thomas H
Biomaterials Science and Engineering, Genzyme Corporation, Framingham, Massachusetts 01701, USA.
J Invest Surg. 2012 Jun;25(3):174-80. doi: 10.3109/08941939.2011.615894.
Chemically modified sodium hyaluronate and carboxymethylcellulose (HA/CMC) membrane clinically reduces adhesion formation following surgery but was not designed for laparoscopic use. HA/CMC powder of identical chemical composition has been developed to allow for application laparoscopically. We compared the adhesion reduction efficacy of HA/CMC powder and film when applied directly to or remote from sites of surgical trauma. We also investigated the effect of the powder on wound healing.
Two animal models of adhesion formation were used to evaluate efficacy: a rat peritoneal sidewall defect model and a rabbit cecal abrasion/sidewall defect model. The products were applied directly to the defect or the contralateral sidewall. Adhesions were examined seven days after surgery. In a separate study, the effect of the powder on healing was evaluated at 5, 7, and 28 days using a rat incisional wound strength model.
HA/CMC powder and film, when applied directly to the peritoneal defect, significantly reduced adhesions relative to the untreated control in both models. Remote applications of HA/CMC powder also reduced adhesions. In contrast, remote applications of HA/CMC film had no effect. HA/CMC powder did not significantly alter incisional wound strength at any of the timepoints tested.
In our preclinical models, HA/CMC powder had similar adhesion reduction efficacy to HA/CMC film when applied directly to sites of trauma. In addition, HA/CMC powder reduced adhesions remote from the application site. Importantly, HA/CMC powder did not impair incisional wound healing. On the basis of these results, future investigation of HA/CMC powder is warranted.
化学修饰的透明质酸钠和羧甲基纤维素（HA/CMC）膜在临床上可减少术后粘连形成，但并非为腹腔镜使用而设计。现已开发出化学成分相同的HA/CMC粉末，以便于腹腔镜应用。我们比较了HA/CMC粉末和薄膜直接应用于手术创伤部位或远离手术创伤部位时减少粘连的效果。我们还研究了该粉末对伤口愈合的影响。
使用两种粘连形成的动物模型来评估疗效：大鼠腹膜侧壁缺损模型和兔盲肠擦伤/侧壁缺损模型。将产品直接应用于缺损处或对侧腹壁。术后7天检查粘连情况。在另一项研究中，使用大鼠切口伤口强度模型在第5、7和28天评估该粉末对愈合的影响。
在两个模型中，HA/CMC粉末和薄膜直接应用于腹膜缺损处时，相对于未治疗的对照组，均显著减少了粘连。HA/CMC粉末在远离手术部位应用时也减少了粘连。相比之下，HA/CMC薄膜在远离手术部位应用时没有效果。在任何测试时间点，HA/CMC粉末均未显著改变切口伤口强度。
在我们的临床前模型中，HA/CMC粉末直接应用于创伤部位时，减少粘连的效果与HA/CMC薄膜相似。此外，HA/CMC粉末减少了远离应用部位的粘连。重要的是，HA/CMC粉末不会损害切口伤口愈合。基于这些结果，有必要对HA/CMC粉末进行进一步研究。
