Ditzel M, Deerenberg E B, Komen N, Mulder I M, Jeekel H, Lange J F
Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Eur Surg Res. 2012;48(4):187-93. doi: 10.1159/000337741. Epub 2012 Jun 5.
Postoperative adhesion formation remains a major clinical problem. The aim of this study was to test the effect of a new hydrogel on adhesion formation in a rat model.
A reproducible rat model was used to induce standardized adhesion formation in three experiments. In experiment 1, a cross-linked polyvinyl alcohol (PVA) and carboxymethylcellulose (CMC) hydrogel (PVA/CMC, A-Part®; B. Braun Aesculap, Germany) was tested in different dosages. In experiment 2, PVA/CMC gel was compared to icodextrin 4% (Adept®; Baxter USA). In both groups, animals were sacrificed after 2 weeks. In experiment 3, histological examination after 4 and 6 weeks was performed. The percentage of adhesions to the defect was measured and the density was determined according to the Zühlke scale. During histological examination of the abdominal wall, the formation of neoperitoneum and potential residues of the agents were assessed.
In experiment 1, a significant reduction in amount as well as density of the adhesions was visible with all dosages of PVA/CMC gel. In experiment 2, again quantity and density of the adhesions were diminished by PVA/CMC hydrogel compared to the control group. Icodextrin 4% showed no significant reduction in adhesion formation. In experiment 3, no residues of PVA/CMC gel or icodextrin 4% were found during histological examination after 4 and 6 weeks and neoperitoneum was present in all cases.
PVA/CMC hydrogel appears to be a novel effective adhesion prevention agent. Together with an upcoming safety study, these data encourage to start clinical efficacy studies.
术后粘连形成仍然是一个主要的临床问题。本研究的目的是在大鼠模型中测试一种新型水凝胶对粘连形成的影响。
在三个实验中使用可重复的大鼠模型诱导标准化的粘连形成。在实验1中，测试了不同剂量的交联聚乙烯醇（PVA）和羧甲基纤维素（CMC）水凝胶（PVA/CMC，A-Part®；德国贝朗蛇牌）。在实验2中，将PVA/CMC凝胶与4%艾考糊精（Adept®；美国百特）进行比较。在两组中，动物在2周后处死。在实验3中，在4周和6周后进行组织学检查。测量粘连至缺损的百分比，并根据祖尔克量表确定密度。在腹壁组织学检查期间，评估新腹膜的形成和药物的潜在残留。
在实验1中，所有剂量的PVA/CMC凝胶均可见粘连数量和密度显著降低。在实验2中，与对照组相比，PVA/CMC水凝胶再次使粘连的数量和密度降低。4%艾考糊精在粘连形成方面未显示出显著降低。在实验3中，在4周和6周后的组织学检查中未发现PVA/CMC凝胶或4%艾考糊精的残留，并且所有病例均存在新腹膜。
PVA/CMC水凝胶似乎是一种新型有效的粘连预防剂。连同即将进行的安全性研究，这些数据鼓励开展临床疗效研究。
