Hopkins M P, Shellhaas C, Clark T, Stakleff K S, Jenison E L
Department of Obstetrics & Gynecology, Northeastern Ohio Universities College of Medicine, Akron 44307.
Gynecol Oncol. 1993 Nov;51(2):210-3. doi: 10.1006/gyno.1993.1274.
The effect of introducing intraperitoneal carboplatinum on wound healing immediately after wound closure was studied using a rat model. All animals were opened through a midline incision. A bowel anastomosis was then performed in a single-or two-layer fashion using 6-O suture. Immediately after closing the abdominal wall, each animal was percutaneously injected with either normal saline for controls (n = 11), or carboplatinum, 3 (n = 8), 9, (n = 19, or 12 mg/kg (n = 4). Abdominal and skin incisions were closed separately using 4-O silk suture. Animals were sacrificed 7 days postoperatively. Adhesions were blindly assessed on the following scale: 0 (no adhesions), 1 (filmy adhesions), 2 (firm adhesions), and 3 (dense adhesions). Anastomoses were assessed for leakage. Three centimeters of the incision were harvested to evaluate wound breaking strength. Analysis of abdominal wound breaking strengths showed control = 1320 g +/- 220, 3 mg = 1055 g +/- 155, 9 mg = 891 g +/- 127, and 12 mg = 594 g +/- 165 (P < 0.025). Evaluation for dense adhesions resulted in control = 27%, 3 mg/kg = 50%, 9 mg = 63%, and 12 mg = 100% (P < 0.0001). Immediate instillation of intraperitoneal carboplatinum had a significant effect on wound healing with a decrease in abdominal tensile strength directly related to the dose instilled. It also had a significant effect on adhesion formation with a higher dose leading to a higher incidence of adhesion formation. Based on animal model data, it appears that the immediate instillation of intraperitoneal carboplatinum at the time of laparotomy incision closure could lead to significant problems with wound strength and adhesion formation.
采用大鼠模型研究了腹腔内注入卡铂对伤口闭合后即刻伤口愈合的影响。所有动物均经中线切口打开腹腔。然后用6-0缝线以单层或双层方式进行肠吻合术。腹壁闭合后，立即经皮给每只动物注射生理盐水作为对照（n = 11），或注射卡铂，剂量分别为3mg/kg（n = 8）、9mg/kg（n = 19）或12mg/kg（n = 4）。用4-0丝线分别闭合腹部和皮肤切口。术后7天处死动物。粘连情况采用以下分级进行盲法评估：0级（无粘连）、1级（薄膜状粘连）、2级（牢固粘连）和3级（致密粘连）。评估吻合口有无渗漏。取3厘米长的切口组织评估伤口抗裂强度。腹部伤口抗裂强度分析结果显示，对照组为1320克±220克，3mg/kg组为1055克±155克，9mg/kg组为891克±127克，12mg/kg组为594克±165克（P < 0.025）。致密粘连评估结果为，对照组为27%，3mg/kg组为50%，9mg/kg组为63%，12mg/kg组为100%（P < 0.0001）。腹腔内即刻注入卡铂对伤口愈合有显著影响，腹部抗张强度降低与注入剂量直接相关。它对粘连形成也有显著影响，较高剂量导致粘连形成的发生率更高。基于动物模型数据，似乎在剖腹手术切口闭合时即刻腹腔内注入卡铂可能会导致伤口强度和粘连形成方面的重大问题。
