Korell M, Scheidel P, Hepp H
Department of Obstetrics and Gynecology, Klinikum Grosshadern, Ludwig Maximilian Universität, Munich, Germany.
J Invest Surg. 1994 Sep-Oct;7(5):409-15. doi: 10.3109/08941939409016507.
The problem of postoperative adhesions remains unsolved. The formation of readhesions after tubal reconstructive surgery reduces the success rate. We have developed a modified uterine horn model in the rat to study the influence of peritoneal transplants on readhesion formation. A total of 58 rats were operated. In 25 animals (group III) the uterine horn was scratched on both sides and then sutured together. During relaparotomy 14 days later the tight connection between both sides was cut. The resulting defect was covered by a peritoneal transplant on one side (group IIIb) and was left open on the control side (group IIIa). After 14 days the presence or absence of adhesions was explored. There was a significant difference (p < .001) between the covered (28%) and uncovered (84%) peritoneal defects with respect to incidence of adhesions. To compare the different characteristics of visceral and parietal peritoneum, a pelvic sidewall defect was induced in 33 animals. There was no significant difference between covering the defect by a peritoneal transplant (group II; 42.9%) and the control side (group I; 33.3%). These data suggest that defects on visceral peritoneum should be closed to prevent adhesion formation. The incidence of adhesions after injury of parietal peritoneum seems to be much lower and of less clinical significance.
术后粘连问题仍未解决。输卵管重建手术后再次粘连的形成会降低成功率。我们在大鼠身上开发了一种改良的子宫角模型,以研究腹膜移植对再次粘连形成的影响。总共对58只大鼠进行了手术。在25只动物(III组)中,双侧子宫角进行划痕,然后缝合在一起。14天后再次剖腹手术时,切断双侧之间的紧密连接。由此产生的缺损一侧用腹膜移植覆盖(IIIb组),对照侧保持开放(IIIa组)。14天后探查有无粘连。在粘连发生率方面,覆盖的(28%)和未覆盖的(84%)腹膜缺损之间存在显著差异(p <.001)。为了比较脏腹膜和壁腹膜的不同特性,在33只动物中诱导形成盆腔侧壁缺损。用腹膜移植覆盖缺损(II组;42.9%)与对照侧(I组;33.3%)之间无显著差异。这些数据表明,应封闭脏腹膜上的缺损以防止粘连形成。壁腹膜损伤后粘连的发生率似乎要低得多,临床意义也较小。