Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
Surg Infect (Larchmt). 2012 Dec;13(6):396-400. doi: 10.1089/sur.2011.114. Epub 2012 Dec 16.
Adhesions follow abdominal surgery with an incidence as high as 95%, resulting in invalidating complications such as bowel obstruction, female infertility, and chronic pain. Searches have been performed for a safe and effective adhesion barrier; however, such barriers have impaired anastomotic site healing. The primary aim of this study was to investigate the effect of a new adhesion barrier, polyvinyl alcohol gel, on healing of colonic anastomoses using a rat model.
Thirty-two Wistar rats were divided in two groups. In all animals, an anastomosis was constructed in the ascending colon. The first group received no adhesion barrier, whereas in the second group, 2 mL of polyvinyl alcohol gel (A-Part Gel(®); Aesculap AG, Tuttlingen, Germany) was applied circularly around the anastomosis. All animals were sacrificed on the seventh post-operative day, and the abdomen was inspected for signs of anastomotic leakage. The anastomotic bursting pressure, the adhesions around the anastomosis, and the collagen content of the excised anastomosis were measured.
No significant differences were observed between the two groups in the incidence of anastomotic leakage, the anastomotic bursting pressure (p=0.08), or the collagen concentration (p=0.91). No significant reduction in amount of adhesions was observed in the rats receiving polyvinyl alcohol gel.
This experimental study showed no significant differences in anastomotic leakage, anastomotic bursting pressure, or collagen content of the anastomosis when using the adhesion barrier polyvinyl alcohol around colonic anastomoses. The barrier did not prevent adhesion formation.
粘连是腹部手术后的一种常见并发症,发生率高达 95%,可导致肠阻塞、女性不孕和慢性疼痛等无效性并发症。人们一直在寻找一种安全有效的粘连屏障,但这种屏障会损害吻合部位的愈合。本研究的主要目的是使用大鼠模型研究一种新型粘连屏障——聚乙烯醇凝胶对结肠吻合口愈合的影响。
将 32 只 Wistar 大鼠分为两组。所有动物的升结肠均进行吻合术。第一组不使用粘连屏障,第二组在吻合口周围环状涂抹 2 mL 聚乙烯醇凝胶(A-Part Gel®;Aesculap AG,Tuttlingen,德国)。所有动物均在术后第 7 天处死,检查腹部吻合口有无渗漏迹象。测量吻合口爆裂压、吻合口周围粘连和切除吻合口的胶原含量。
两组在吻合口漏的发生率、吻合口爆裂压(p=0.08)或胶原浓度(p=0.91)方面均无显著差异。使用聚乙烯醇凝胶的大鼠粘连数量未见明显减少。
本实验研究表明,在使用聚乙烯醇作为粘连屏障时,结肠吻合口的吻合口漏、吻合口爆裂压或吻合口胶原含量均无显著差异。该屏障不能防止粘连形成。