Hamaji Masatsugu, Kojima Fumitsugu, Komatsu Teruya, Tsuruyama Tatsuaki, Date Hiroshi, Nakamura Tatsuo
Department of Bioartificial Organs, Graduate School of Medicine, Kyoto University, Kyoto, Japan Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Department of Bioartificial Organs, Graduate School of Medicine, Kyoto University, Kyoto, Japan Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Interact Cardiovasc Thorac Surg. 2014 Dec;19(6):914-20. doi: 10.1093/icvts/ivu299. Epub 2014 Sep 12.
Intrapleural adhesions following thoracotomy may be associated with prolonged operating time or a higher complication rate at reoperation. The aim of this experimental study was to investigate the anti-adhesion property of a bioabsorbable sheet following thoracotomy in a canine model.
Ten adult beagle dogs underwent bilateral muscle-sparing thoracotomies with single ribs resected under general anaesthesia. A bioabsorbable sheet composed of poly-L-lactide copolymer (45 wt%) and ε-caprolactone (45 wt%) layered with polyglycolic acid (10 wt%) was sutured intrapleurally on the parietal pleura to cover the defect on the left, but not placed on the right side as a control. All the dogs were followed up with chest computed tomography until being sacrificed (6 months at the maximum). Thoracoscopic evaluations were performed at 1, 3 and 6 months for intrapleural adhesions at the thoracotomy site and absorption of the bioabsorbable sheet. The incidences of intrapleural adhesions were compared between the experimental side and the control side by the χ(2) test. Histological (macroscopic and microscopic) analyses of regenerated chest wall tissue were also performed at 1, 3 and 6 months.
All the dogs survived uneventfully until being sacrificed without any postoperative complications or significant radiological findings. The bioabsorbable sheet prevented intrapleural adhesions in all subjects. There were statistically significant differences in the incidence of intrapleural adhesions between the experimental side and the control side at the thoracotomy incision (0 vs 80%, P = 0.0014) at 1 month, (0 vs 66.7%, P = 0.014) at 3 months and (0 vs 75%, P = 0.028) at 6 months. The bioabsorbable sheet was found residual at 1, 3 and 6 months in all subjects. Histological analyses confirmed regenerated chest wall layers with significantly more capillary vessels at 1 month (P = 0.015), but not at 3 and 6 months (P = 0.84 and 0.41, respectively), in the regenerated mucosal and submucosal layers on the experimental side.
Our findings suggest that the bioabsorbable sheet may prevent intrapleural adhesions with parietal pleurae regenerated with more vascularization at 1 month following thoracotomy. No adverse findings were noted with the sheet.
开胸术后胸膜粘连可能与手术时间延长或再次手术时更高的并发症发生率相关。本实验研究的目的是在犬模型中研究一种生物可吸收片材在开胸术后的抗粘连特性。
10只成年比格犬在全身麻醉下接受双侧保留肌肉的开胸手术，切除单根肋骨。将由聚-L-丙交酯共聚物（45重量%）和ε-己内酯（45重量%）与聚乙醇酸（10重量%）分层组成的生物可吸收片材胸膜内缝合于壁层胸膜上，以覆盖左侧的缺损，但右侧不放置作为对照。所有犬均接受胸部计算机断层扫描随访直至处死（最长6个月）。在1、3和6个月时进行胸腔镜评估，观察开胸部位的胸膜粘连情况及生物可吸收片材的吸收情况。通过χ²检验比较实验侧和对照侧胸膜粘连的发生率。在1、3和6个月时还对再生胸壁组织进行了组织学（宏观和微观）分析。
所有犬均顺利存活直至处死，无任何术后并发症或明显的影像学表现。生物可吸收片材在所有受试对象中均防止了胸膜粘连。在1个月时，实验侧和对照侧开胸切口处胸膜粘连的发生率有统计学显著差异（0比80%，P = 0.0014）；3个月时（0比66.7%，P = 0.014）；6个月时（0比75%，P = 0.028）。在所有受试对象中，生物可吸收片材在1、3和6个月时均有残留。组织学分析证实，实验侧再生的黏膜和黏膜下层在1个月时有明显更多的毛细血管（P = 0.015），但在3个月和6个月时没有（分别为P = 0.84和0.41）。
我们的研究结果表明，生物可吸收片材可能预防开胸术后1个月时壁层胸膜间的胸膜粘连，且壁层胸膜再生时有更多血管化。该片材未观察到不良表现。
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