Canadian Surgical Technologies and Advanced Robotics (CSTAR), London Health Sciences Centre, London, ON, USA.
Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Surg Endosc. 2019 Aug;33(8):2517-2520. doi: 10.1007/s00464-018-6540-2. Epub 2018 Oct 22.
Adhesions are a known cause of morbidity and mortality following abdominal surgery. Multiple approaches have been evaluated to prevent or minimize the occurrence of adhesions. Administration of aerosolized heparin and hyaluronic acid is an effective method to prevent postoperative adhesions whether they are used independently or in synergism. However, absorption rate and the systemic effect of heparin given intra-peritoneal have never been investigated. The purpose of this study was to evaluate the systemic effect and the absorption rate of heparin with or without hyaluronic acid in the prevention of postoperative abdominal adhesion.
This is a cross-sectional study comparing thirty rats (n = 30) divided into 3 groups, each consisting of 10 rats. First group (n = 10) received aerosolized intra-peritoneal heparin (IPH). Second group (n = 10) received intra-peritoneal heparin with hyaluronic acid (IPHHA). Intravenous heparin (IVH) was given to the third group (n = 10). Serum heparin levels were measured and compared between the groups over 120 min's period.
None of the rats had intra-operative bleeding. The level of serum heparin was significantly lower in the IPHHA group compared to IPH and the IVH at all points of measurements (30, 60, 90, and 120 min) (p < 0.0001). The serum level of heparin of all groups peaked at 90 min. Area-under-the-curve 0-120 was significantly lower in the IPHHA group as compared to both IPH and IVH (p < 0.0001).
The aerosolized intra-peritoneal administration of heparin or heparin with hyaluronic acid resulted in minimal systemic absorption rendering it safe for the use as method to prevent intra-peritoneal adhesions. Human studies are planed next.
粘连是腹部手术后发病率和死亡率的已知原因。已经评估了多种方法来预防或尽量减少粘连的发生。雾化肝素和透明质酸的给药是一种有效的方法，可以预防术后粘连，无论它们是单独使用还是协同使用。然而，尚未研究肝素腹腔内给药的吸收速率和全身效应。本研究旨在评估肝素联合或不联合透明质酸预防术后腹部粘连的全身效应和吸收速率。
这是一项比较 30 只大鼠（n=30）的横断面研究，将其分为 3 组，每组 10 只大鼠。第 1 组（n=10）接受雾化腹腔内肝素（IPH）。第 2 组（n=10）接受腹腔内肝素联合透明质酸（IPHHA）。第 3 组（n=10）给予静脉肝素（IVH）。测量各组在 120 分钟内的血清肝素水平并进行比较。
所有大鼠均无术中出血。与 IPH 和 IVH 相比，IPHHA 组的血清肝素水平在所有测量点（30、60、90 和 120 分钟）均显著降低（p<0.0001）。所有组的血清肝素水平均在 90 分钟时达到峰值。与 IPH 和 IVH 相比，IPHHA 组的 0-120 分钟曲线下面积明显较低（p<0.0001）。
雾化腹腔内给予肝素或肝素联合透明质酸可导致最小的全身吸收，使其可安全用于预防腹腔内粘连。计划进行下一步的人体研究。
