Diamond M P, DeCherney A H, Linsky C B, Cunningham T, Constantine B
Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut.
Int J Fertil. 1988 Sep-Oct;33(5):372-5.
Adhesion re-formation frequently complicates the performance of adhesiolysis in reproductive pelvic surgery. To assess the ability of carboxymethylcellulose (CMC) to reduce adhesion re-formation, a rabbit uterine horn model was employed. Adhesions were created at laparotomy by scraping a 5-cm segment of each uterine horn. This injury reproducibly creates adhesions. Two weeks later, repeat laparotomy was performed, at which time all adhesions were lysed by sharp dissection. Animals were then randomly assigned to the control or CMC (20 mL of 2% solution) group. Necropsy was performed 2 weeks later. At both the second operative procedure and the time of necropsy, adhesions were graded in a blind fashion for severity and tenacity. There was no difference in adhesion score in the control and CMC-treated rabbits at the time of adhesiolysis. Subsequently, at the time of necropsy, the mean adhesion reformation score in the control group was 3.96 (median = 4.0). In contrast, adhesion re-formation in the CMC-treated group was significantly less (mean score = 2.15; median = 2.0; sign test, P less than .01). In summary, CMC significantly reduced adhesion re-formation in the rabbit uterine horn model. The mechanism by which CMC was able to reduce adhesion reformation is uncertain, but may be related to "hydroflotation" or "siliconizing" effects.
粘连再形成常使生殖盆腔手术中粘连松解的效果复杂化。为评估羧甲基纤维素（CMC）减少粘连再形成的能力，采用了兔子宫角模型。通过刮擦每个子宫角5厘米的节段在剖腹术中造成粘连。这种损伤可重复性地产生粘连。两周后，进行再次剖腹术，此时所有粘连均通过锐性分离予以松解。然后将动物随机分为对照组或CMC组（2%溶液20毫升）。两周后进行尸检。在第二次手术操作及尸检时，以盲法对粘连的严重程度和坚韧度进行分级。在粘连松解时，对照组和接受CMC治疗的兔的粘连评分无差异。随后，在尸检时，对照组的平均粘连再形成评分为3.96（中位数 = 4.0）。相比之下，接受CMC治疗组的粘连再形成明显较少（平均评分 = 2.15；中位数 = 2.0；符号检验，P小于0.01）。总之，在兔子宫角模型中，CMC显著减少了粘连再形成。CMC能够减少粘连再形成的机制尚不确定，但可能与“水漂浮”或“硅化”效应有关。
