Mitchell J D, Lee R, Neya K, Vlahakes G J
Department of Surgery, Massachusetts General Hospital, Boston 02114.
Eur J Cardiothorac Surg. 1994;8(3):149-52. doi: 10.1016/1010-7940(94)90172-4.
Various materials have been suggested for pericardial closure following cardiac surgery to limit postoperative adhesion formation. Unfortunately, these devices have caused difficulties with infection, calcification, and epicardial scar formation. A bioabsorbable membrane with a short in-vivo persistence time, acting as a barrier to adhesion formation until mesothelial healing occurs, might obviate many of these problems. We examined the efficacy of a bioabsorbable membrane containing hyaluronic acid in the prevention of experimental pericardial adhesions; hyaluronic acid solutions have been shown experimentally to reduce adhesions following abdominal, orthopedic and cardiac surgery. Eleven dogs underwent sternotomy and pericardiotomy followed by 2-h protocol of desiccation and abrasion of pericardial and epicardial surfaces. In five dogs, the epicardial surfaces were covered with the test material, followed by pericardial and sternotomy closure. Six dogs served as controls. All animals underwent resternotomy 8 weeks after surgery; intrapericardial adhesions were graded on a severity scale (0-4). The test animals (mean adhesion score 1.4 +/- 0.5) had either no adhesions or filmy, avascular adhesions easily taken down with blunt dissection. In contrast, dense adhesions were found in the control animals (mean score 3.2 +/- 0.4), frequently obscuring tissue planes and epicardial anatomy. Use of the bioabsorbable membrane significantly reduced adhesion formation (test vs control, P < 0.001, Mann-Whitney test). We conclude that a hyaluronic acid membrane reduces postoperative pericardial adhesions in this canine model, and that the use of a bioabsorbable barrier in the prevention of pericardial adhesions warrants further investigation.
心脏手术后，人们提出了各种材料用于心包闭合，以限制术后粘连的形成。不幸的是，这些装置引发了感染、钙化和心外膜瘢痕形成等问题。一种体内存留时间短的生物可吸收膜，可在间皮愈合前作为粘连形成的屏障，或许能避免许多此类问题。我们研究了一种含透明质酸的生物可吸收膜预防实验性心包粘连的效果；实验表明，透明质酸溶液可减少腹部、骨科和心脏手术后的粘连。11只狗接受胸骨切开术和心包切开术，然后进行2小时的心包和心外膜表面干燥及擦伤操作。5只狗的心外膜表面覆盖测试材料，随后进行心包和胸骨切开术闭合。6只狗作为对照。所有动物在术后8周接受再次胸骨切开术；心包内粘连按严重程度分级（0 - 4级）。测试动物（平均粘连评分1.4 ± 0.5）要么没有粘连，要么有薄膜状、无血管的粘连，用钝性分离很容易取下。相比之下，对照动物中发现有致密粘连（平均评分3.2 ± 0.4），常使组织层面和心外膜解剖结构模糊不清。使用生物可吸收膜显著减少了粘连形成（测试组与对照组相比，P < 0.001，曼 - 惠特尼检验）。我们得出结论，在这个犬类模型中，透明质酸膜可减少术后心包粘连，并且使用生物可吸收屏障预防心包粘连值得进一步研究。
