Department of Obstetrics and Gynecology, American University of Beirut Medical Center , Beirut , Lebanon.
Department of Anatomy, Cell Biology and Physiology, American University of Beirut Medical Center , Beirut , Lebanon.
Front Med (Lausanne). 2016 Mar 29;3:10. doi: 10.3389/fmed.2016.00010. eCollection 2016.
Adhesions after abdomino-pelvic surgery are a cause of morbidity and reoperations. The use of human amniotic membrane (HAM) for adhesion prevention has given controversial results. The mode of administration of the amniotic membrane has not been well studied. This study assessed the efficacy of two modes of application of cryopreserved HAM, patch or fragmented in Lactated Ringer (LR) solution, for the prevention of pelvic adhesion formation postabdomino-pelvic surgery in a mice model. After a midline laparotomy incision, a small cautery lesion was done on each side of the abdominal wall peritoneum in mice. In Group A (control; n = 42), the abdomen was closed directly, Group B (n = 42) received 2.5 ml of LR prior to closure. In Groups C (n = 42) and D (n = 42), a 2 cm × 2 cm patch of HAM and another one fragmented and dispersed in 2.5 ml of LR were applied prior to closure, respectively. Two weeks later, a laparotomy was performed, and gross and pathological evaluation of adhesions, fibrosis, angiogenesis, and inflammation were conducted. Group D exhibited a significantly lower rate of gross adhesion formation. Fibrosis was significantly lowest in Group C as compared to the control. Group B had the lowest vascular formation in the adhesions. The use of HAM fragmented in LR solution is associated with a significantly lower incidence of postoperative adhesions in mice when compared to LR alone, HAM patch, or control. The mechanism of action of this reduction needs to be elucidated by future studies.
腹盆腔手术后粘连是发病率和再手术的原因。使用人羊膜（HAM）预防粘连的效果存在争议。羊膜的给药方式尚未得到充分研究。本研究评估了两种应用冷冻保存 HAM 的方式（贴剂或碎片在乳酸林格氏液（LR）中）预防小鼠腹盆腔手术后盆腹腔粘连形成的效果。在进行中线剖腹手术后，在小鼠腹壁腹膜的每侧进行小的电烙损伤。在 A 组（对照组；n=42）中，直接关闭腹部，B 组（n=42）在关闭前给予 2.5 ml LR。在 C 组（n=42）和 D 组（n=42）中，在关闭前分别应用 2cm×2cm 的 HAM 贴剂和另一片碎片分散在 2.5 ml LR 中。2 周后进行剖腹术，并对粘连、纤维化、血管生成和炎症进行大体和病理评估。D 组的大体粘连形成率显著降低。与对照组相比，C 组的纤维化程度显著最低。B 组的粘连中血管形成最低。与单独使用 LR 相比，LR 溶液中 HAM 碎片的应用与小鼠术后粘连发生率显著降低相关，与 HAM 贴剂或对照组相比。这种减少的作用机制需要通过未来的研究来阐明。
