Ntourakis Dimitrios, Katsimpoulas Michail, Tanoglidi Anna, Barbatis Calypso, Karayannacos Panayotis E, Sergentanis Theodoros N, Kostomitsopoulos Nikolaos, Machairas Anastasios
Foundation of Biomedical Research, Academy of Athens, Athens, Greece Hellenic Red Cross Hospital, Athens, Greece
Foundation of Biomedical Research, Academy of Athens, Athens, Greece.
Surg Innov. 2016 Jun;23(3):266-76. doi: 10.1177/1553350615610653. Epub 2015 Oct 15.
Background Postoperative adhesions are the result of aberrant peritoneal healing. As they are the leading cause of postoperative bowel obstruction, anti-adherence barriers are advocated for their prevention. This study looks into the effect of these biomaterials on the healing of intestinal anastomoses. Materials and Methods Thirty-three New Zealand White rabbits underwent laparotomy, transection of the terminal ileum, and creation of an end-to-end anastomosis. Animals were randomized into 3 groups: the Control group (n = 11); the Icodextrin group, receiving icodextrin 4% intraperitonealy (n = 11); and the HA/CMC group, having the anastomosis wrapped with a hyaluronic acid/carboxymethylcellulose film (n = 11). All animals were sacrificed on the seventh postoperative day. Macroscopic adhesions were graded and anastomotic strength was tested by the burst pressure. Histological healing was assessed in a semiquantitative way for the presence of ulceration, reepithelization, granulation tissue, inflammation, eosinophilic infiltration, serosal inflammation, and microscopic adhesions. Univariate and multivariate analysis was used. Results are given as medians with interquartile range. Results The median adhesion scores were the following: Control 1 (0-3), Icodextrin 0 (0-1), HA/CMC 0 (0-0), P = .017. The burst pressure did not differ between the groups; however, all except one bowel segments tested burst away from the anastomosis. The macroscopic and histological anastomotic healing was comparable in all 3 groups. A poor histological anastomotic healing score was associated with a higher adhesion grade (odds ratio = 1.92; 95% confidence interval = 1.06-3.47; P = .032). Conclusion Adhesion formation was inhibited by the materials tested without direct detrimental effects on anastomotic healing. Poor anastomotic healing provokes adhesions even in the presence of anti-adhesion barriers.
背景 术后粘连是腹膜异常愈合的结果。由于它们是术后肠梗阻的主要原因，因此提倡使用抗粘连屏障来预防。本研究探讨了这些生物材料对肠吻合口愈合的影响。
材料与方法 33只新西兰白兔接受剖腹手术、回肠末端横断术并进行端端吻合。动物被随机分为3组：对照组（n = 11）；艾考糊精组，腹腔内注射4%艾考糊精（n = 11）；透明质酸/羧甲基纤维素（HA/CMC）组，用透明质酸/羧甲基纤维素膜包裹吻合口（n = 11）。所有动物在术后第7天处死。对宏观粘连进行分级，通过爆破压力测试吻合口强度。对溃疡、再上皮化、肉芽组织、炎症、嗜酸性粒细胞浸润、浆膜炎症和微观粘连的存在进行半定量评估组织学愈合情况。采用单因素和多因素分析。结果以中位数和四分位数间距表示。
结果 粘连评分中位数如下：对照组1（0 - 3），艾考糊精组0（0 - 1），HA/CMC组0（0 - 0），P = 0.017。各组之间爆破压力无差异；然而，除一个测试的肠段外，所有肠段均在吻合口以外破裂。所有3组的宏观和组织学吻合口愈合情况相当。组织学吻合口愈合评分差与粘连等级较高相关（比值比 = 1.92；95%置信区间 = 1.06 - 3.47；P = 0.032）。
结论 所测试的材料抑制了粘连形成，且对吻合口愈合无直接有害影响。即使存在抗粘连屏障，吻合口愈合不良也会引发粘连。
