Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
J Surg Res. 2019 Nov;243:453-459. doi: 10.1016/j.jss.2019.05.043. Epub 2019 Aug 1.
Intra-abdominal adhesions affect up to 93% of the patients after abdominal surgery, causing small-bowel obstruction, infertility, chronic abdominal pain, and iatrogenic bowel injury at reoperation. The efficacy of five new polymer antiadhesive barriers to avoid adhesion formation is evaluated in an ischemic button model in rats.
Five new, biodegradable polyurethane and copolyester-based, antiadhesive barriers (A1, A2, A3, B1, and B2) were evaluated in separate experimental groups and compared with two control groups (hyaluronate carboxymethylcellulose barrier and no antiadhesive barrier) in an ischemic button model (n = 11 per group operated). After 14 d, the quantity and quality of the adhesions were scored macroscopically. The Kruskal-Wallis with Mann-Whitney U post hoc and the Fisher's exact tests were used for data analysis. The Bonferroni correction method was applied, and a P-value <0.007 was considered significant.
Two animals died during surgery and follow-up. A significant reduction of adhesions to ischemic buttons was found in the A2 group (median, 3.5; interquartile range, 2.25) compared with no adhesive barrier (median, 8.0; interquartile range, 2.0) (P = 0.001). The remaining groups did not differ significantly regarding adhesion quantity or quality. Adverse events were observed in the A2, A3, and B2 groups.
The A2 antiadhesive barrier reduced the adhesion formation significantly compared with no anti-adhesive barrier, but applicability is questionable because of extensive adverse events observed due to implantation of the anti-adhesive barrier. The Nair score appears not to be sensitive enough to detect differences in adhesion formation in this model. Future research should focus on anti-adhesive barriers that are self-adhering.
腹部手术后，多达 93%的患者会出现腹腔内粘连，导致小肠梗阻、不孕、慢性腹痛和再次手术时医源性肠损伤。在大鼠缺血纽扣模型中评估了五种新的聚合物防粘连屏障以避免粘连形成的效果。
在缺血纽扣模型中，将五种新的、可生物降解的基于聚氨酯和共聚聚酯的防粘连屏障（A1、A2、A3、B1 和 B2）分别在单独的实验组中进行评估，并与两组对照组（透明质酸羧甲基纤维素屏障和无防粘连屏障）进行比较（每组 n=11 例手术）。术后 14 天，宏观评分粘连的数量和质量。使用 Kruskal-Wallis 检验和 Mann-Whitney U 检验进行数据分析。Fisher 确切概率法用于数据处理。Bonferroni 校正法应用，P 值<0.007 认为有统计学意义。
手术和随访过程中有 2 只动物死亡。与无防粘连屏障组（中位数 8.0；四分位距 2.0）相比，A2 组缺血纽扣的粘连量明显减少（中位数 3.5；四分位距 2.25）（P=0.001）。其余组在粘连数量或质量方面无显著差异。A2、A3 和 B2 组观察到不良事件。
与无防粘连屏障相比，A2 防粘连屏障可显著减少粘连形成，但由于植入防粘连屏障后观察到广泛的不良事件，其适用性值得怀疑。Nair 评分似乎不足以检测到该模型中粘连形成的差异。未来的研究应集中在具有自粘特性的防粘连屏障上。
