Orhan Atilla, Görmüş Niyazi, Toy Hatice, Görmüş Işık Solak, Çağlayan Osman, Tanyeli Ömer
Farabi Hospital, Dept. of Cardiovascular Surgery, Konya, Turkey.
Necmettin Erbakan University, Meram Medical School, Dept. of Cardiovascular Surgery, Konya, Turkey.
Heart Lung Circ. 2014 Apr;23(4):357-62. doi: 10.1016/j.hlc.2013.10.080. Epub 2013 Oct 23.
Retrosternal pericardial adhesions may cause significant injuries to the heart and great vessels in cases that require reoperation. Fibroblast proliferation is one of the mechanisms for adhesion formation. Inhibition of fibroblast proliferation is important in reduction of retrosternal adhesions. Mitomycin C (MMC) is able to reduce fibroblast proliferation. We aimed to determine the effect of MMC on prevention of retrosternal pericardial adhesions after primary cardiac operations.
Thirty Sprague-Dawley female rats were used in the study. The rats were divided into two groups. First group was control (n=10) and second group was MMC study group (n=20). Xiphoid cartilage resection and retrosternal abrasion via subxiphoidal incision was performed. In the study group, MMC (1mg/kg) was topically applied to the retrosternal space. After 15 days, rats were taken into reoperation and adhesion was graded. Tissue and blood samples were taken before termination procedure. Standard staining procedures and fibroblast growth factor receptor 3 antibody staining, were applied immunohistochemically to tissue samples.
The average adhesion scores of the control (n=10) and study (n=20) (MMC; 1mg/kg) groups were 2.50 ± 1.27 and 0.70 ± 0.86, respectively. The adhesion score of the study group was lower than the control group (p<0.05). Immunohistochemical samples revealed that tissue fibroblast intensity was significantly higher in the control group than the study group (p<0.05). There was no statistical significance between two groups in case of hydroxyproline levels (p>0.05).
MMC was found to be effective in the prevention of retrosternal pericardial adhesions without any delay in normal tissue regeneration.
在需要再次手术的病例中，胸骨后心包粘连可能会对心脏和大血管造成严重损伤。成纤维细胞增殖是粘连形成的机制之一。抑制成纤维细胞增殖对于减少胸骨后粘连很重要。丝裂霉素C（MMC）能够减少成纤维细胞增殖。我们旨在确定MMC对初次心脏手术后预防胸骨后心包粘连的效果。
本研究使用了30只雌性Sprague-Dawley大鼠。将大鼠分为两组。第一组为对照组（n = 10），第二组为MMC研究组（n = 20）。通过剑突下切口进行剑突软骨切除和胸骨后磨损。在研究组中，将MMC（1mg/kg）局部应用于胸骨后间隙。15天后，对大鼠进行再次手术并对粘连进行分级。在终止手术前采集组织和血液样本。对组织样本进行标准染色程序和成纤维细胞生长因子受体3抗体染色的免疫组织化学检测。
对照组（n = 10）和研究组（n = 20）（MMC；1mg/kg）的平均粘连评分分别为2.50±1.27和0.70±0.86。研究组的粘连评分低于对照组（p<0.05）。免疫组织化学样本显示，对照组的组织成纤维细胞强度明显高于研究组（p<0.05）。两组间羟脯氨酸水平无统计学意义（p>0.05）。
发现MMC在预防胸骨后心包粘连方面有效，且不会延迟正常组织再生。
