Alponat A, Lakshminarasappa S R, Teh M, Rajnakova A, Moochhala S, Goh P M, Chan S T
Department of Surgery, National University Hospital, Singapore.
J Surg Res. 1997 Mar;68(2):126-32. doi: 10.1006/jsre.1996.4979.
Adhesion formation between viscera and mesh is almost inevitable following incisional hernia repair with prosthetic mesh. Such adhesions may lead to intestinal obstruction and enterocutaneous fistulae formation and make further laparotomies extremely difficult. Sodium carboxymethylcellulose (SCMC) and Interceed TC7 (oxidized regenerated cellulose) as physical barriers have been shown to be effective in reducing postoperative adhesions.
To evaluate the effects of SCMC and Interceed TC7, we used an incisional hernia model in rats. A ventral abdominal defect (15 x 25 mm) was created in each of 36 male rats which were then divided into three equal groups. In Group I (control) the defect was repaired with polypropylene mesh (PPM) only; in Group II the defect was repaired after a layer of Interceed TC7 was laid over the viscera with Interceed TC7-covered PPM; in Group III the defect was repaired after a layer of SCMC was laid over the viscera with SCMC-coated PPM. Six of the animals from each group were sacrificed at Postoperative Day 7 and the adhesions were scored. The remaining 6 were sacrificed at Day 30 and histological evaluation was made in addition to the adhesion score.
Animals in the SCMC-treated group developed significantly less adhesions (P = 0.0002) compared with control and Interceed TC7-treated groups. However, histological analysis revealed poor fibroblast proliferation with impaired wound healing in the SCMC group.
SCMC prevented adhesion formation but seriously impaired wound healing, and Interceed TC7 was ineffective in preventing adhesion in this model.
使用人工合成补片进行切口疝修补术后，内脏与补片之间几乎不可避免地会形成粘连。这种粘连可能导致肠梗阻和肠皮肤瘘的形成，并使再次开腹手术变得极为困难。羧甲基纤维素钠（SCMC）和Interceed TC7（氧化再生纤维素）作为物理屏障，已被证明可有效减少术后粘连。
为评估SCMC和Interceed TC7的效果，我们在大鼠身上建立了切口疝模型。在36只雄性大鼠身上制造一个腹前壁缺损（15×25毫米），然后将它们平均分为三组。第一组（对照组）仅用聚丙烯补片（PPM）修复缺损；第二组在将一层Interceed TC7覆盖在内脏上后，用覆盖Interceed TC7的PPM修复缺损；第三组在将一层SCMC覆盖在内脏上后，用涂有SCMC的PPM修复缺损。每组6只动物在术后第7天处死，并对粘连情况进行评分。其余6只在第30天处死，除粘连评分外，还进行了组织学评估。
与对照组和Interceed TC7治疗组相比，SCMC治疗组的动物形成的粘连明显更少（P = 0.0002）。然而，组织学分析显示，SCMC组的成纤维细胞增殖不良，伤口愈合受损。
SCMC可防止粘连形成，但严重损害伤口愈合，且在该模型中Interceed TC7在防止粘连方面无效。
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