ObjectiveTo study the influence of infection in incision of abdominal wall on peritoneal adhesion. MethodsOne hundred and twenty white rats were divided into low, medium, high concentration (LC, MC, HC) groups and control group, 30 rats each, and were made animal models of abdominal incision infection, then were respectively given hypodermic injections in incisional wound of 0.2 ml quantitative mixture of Escherichia coli, staphylococcus aureus and pseudomonas aeruginosa in the concentration of 1×102, 1×105 and 1×108 cfu/ml. While the control group,normal saline was given. All the subjects were killed 8 days after operation and compared the peritoneal adhesion among the four groups.ResultsInfection rate of the incisional wounds was 81.48%, 86.67%, 90.00% and 50.00% respectively in LC, MC, HC and the control, peritoneal adhesion rate was 53.33%, 60.00%, 70.00% and 26.67% respectively. There was significant difference between LC and the control (P＜0.05), between MC or HC and the control (P＜0.01). While no difference was among LC, MC and HC (P＞0.05).Conclusion Infection of incision may increase peritoneal adhesion which might not be closely related to the number of the bacteria. This suggests that the prevention of infection plays an important role in preventing peritoneal adhesion.
腹部手术后腹腔粘连是一种常见的临床现象，可导致严重的并发症，如肠梗阻、腹腔和盆腔疼痛、不孕和不育等。严重的腹腔粘连常给再次手术造成极大困难，由于粘连形成过程复杂，治疗效果又十分不理想，所以探索其形成机理及预防措施成为当今外科领域的重点内容之一，本文就此分述如下。
Objective To investigate the way of closed establishment of pneumoperitoneum（CEPP） in patients with peritoneal cavity adhesion in laparoscopy, and to sum up the successful experience and the lesson of visceral injury. Methods CEPP experiences of 1 046 cases of peritoneal adhesion were retrospective analysed in 6 600 cases laparoscopy in our unit from September 1991 to September 1999.The difficulty of establishment of pneumoperitoneum was classified as real difficulty in establishment of pneumoperitonum (RDEPP) and false difficulty in establishment of pneumoperitonum (FDEPPD). RDEPP was due to Veress needle penetrating into viscera or peritoneal extensive adhesion in peritoneal cavity, and CO2 air flowing into difficulty. FDEPP was due to veress needle penetrating into extraperitoneum fat, round hepatic ligament or larger messentry. The formal situation required conversion to open laparotomy, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle direction or penetrating depth in second penetration. Results In this group 1 046 patients, 1 028 cases (98.3%) had been established pneumoperitoneum successfully by way of CEPP, 6 cases of RDEPP and 12 cases of FDEPP required open laparotomy. No complication related to CEPP had been found in this group except two cases visceral injury cured by laparotomy and repairment. Conclusion CEPP in patients with peritoneal adhesion is safe and feasible in laparoscopy. The main reason of CEPP failure is regarding FDEPP as RDEPP due to deficiency of experience and confidence of laparoscopist.
To explore the effect of hydroxybutyl chitosan on the prevention of postoperative peritoneal adhesion in rats. Methods Ninety SD rats (half males and half females) weighing 250-280 g underwent laparotomy with subsequent cecal wall abrasion and peritoneal adhesion. Rats were randomized into 3 groups (n=30 per group): group A, injection of 2 mL hydroxybutyl chitosan solution (2%); group B, injection of 2 mL sodium hyaluronate solution(2%); group C, the abdomen of rat was exposed for 30 seconds and served as control group. The general condition of the rats was observed after operation. The rats were killed 2 and 4 weeks after operation, 15 rats per group at a time, to undergo gross and histologyobservation. The degree of adhesion was evaluated by double-bl ind method. The microstructure of injured electroscope cecal wall in groups A and C was observed with transmission electroscope 4 weeks after operation. Results All rats survived till the end of experiment. At 2 weeks after operation, the adhesion and the hyperplasia of fibrous connective tissue and collagen in groups A and B were sl ight while the adhesion in group C was serious with severe hyperplasia of fibrous connective tissue. According to the measurement classification by Nair histological grading, the difference between groups A and B and group C was significant (P lt; 0.05), while no significant difference was evident between group A and group B (P gt; 0.05). At 4 weeks after operation, the adhesion in group A was mild, and the hyperplasia of fibrous connective tissue and collagen were sl ight; the adhesion and the hyperplasia of fibrous connective tissue and collagen in group C were serious. The levels of group B were between group A and group C. The differences among three groups were significant (P lt; 0.05). Transmission electroscope showed inactive fibroblasts and loose thin collagen fibers in group A, and active fibroblasts and closely collagen fibers arranged in a disorderly manner in group C. Conclusion Hydroxybutyl chitosan can decrease the hyperplasia of fibrous connective tissue and inhibit the activity of fibroblasts significantly, and has a long-term role of preventing peritoneal adhesion.
Objective To investigate the preventive effect of carbachol on the formation of postoperative intra-abdominal adhesion. Methods Forty-four Wistar rats were randomly divided into sham operation group (SO group, n=12), operation group (n=16) and carbachol treated group (carbachol group, n=16, carbachol 50 μg/kg). Animal model of abdominal adhesion was established by rubbing the procussus vermiformis of cecum with dry sterile gauze, and by clamping and scuffing abdominal wall. Half of rats were separately killed on day 7 and day 14 after surgery, respectively. The degree of adhesion was evaluated according to Phillips 5-scale grade and the feature of this model. The histopathological changes of adhesive tissues were observed and the content of collagen type Ⅰ in the tissues was detected by immunohistochemistry. Results The scores of intra-abdominal adhesion were significantly lower in the carbachol group than those in operation group both on 7 d and 14 d (P＜0.01). Mild inflammatory changes and less fibrous proliferation were observed in carbachol group microscopically. The contents of collagen type Ⅰ detected by immunohistochemistry were significantly lower in the carbachol group than those in operation group both on 7 d and 14 d (P＜0.01). There was no significant difference of the score of abdominal adhesion and content of collagen type Ⅰ in the same group between 7 d and 14 d (Pgt;0.05). Conclusion Carbachol may take a significant role in the prevention of postoperative abdominal adhesion in rat.
【Abstract】ObjectiveTo investigate the effects of high molecular bio-degradable film on preventing peritoneal adhesion. MethodsOne hundred and twenty rats were divided into control group, non-bio-degradable film group and polycaprolactone (PCL) group. Animal models of peritoneal adhesion made by operations on rats serve as control group. In the study, non-bio-degradable film and biodegradable, namely PCL films sensitive to pseudomonas enzyme, were put into the opening of peritoneum. The effect of the films on peritoneal adhesion was examined on 1, 3, 7 and 30 d after operation. ResultsPeritoneal adhesion was found in all the rats of control group and very low in PCL group and non-bio-degradable film group. ConclusionPCL film can effectively prevent the formation of postoperative peritoneal adhesion.
Objective To determine the effectiveness of sodium hyaluronate (SHA) in preventing intraperitoneal (IP) adhesion. Methods Thirty-eight rats were randomly divided into A,B,C groups, normal saline, 6% Dextran-40 or SHA were applied on the present serosal injury respectively, during operation. Biopsy was taken on the 14th postoperative day.Results There were statistically significant differences in the extent of adhesion among three groups (Ｐ＜0.01). Mild inflammatory changes and less fibrous proliferation were found in group C by microscopy and decreased production of collagen (by fibroblast) and active mesothelial cells proliferation were observed in group C under electron microscope. Conclusion SHA appeares to reduce the extent of postoperative IP adhesion, which is more satisfactory than Dextran-40.
ObjectiveAdopting poly-L-lactic/glycolic acid (PLGA) and polyethylene glycol (PEG) as the material to fabricate PLGA/PEG electrospun polymer membrane by electrospinning technology. And to study its preventive effect on postoperative intraperitoneal adhesion of rat.MethodsPLGA and PEG were mixed at the ratio of 19∶1(M/M), then dissolved in organic solvent. The PLGA/PEG electrospun polymer membrane was prepared by electrospinning technology, and then the gross observation and scanning electron microscope observation were taken. Fifty-four Sprague Dawley rats (weighing, 180-200 g), were randomly divided into 3 groups. The rats in control group (n=6) were left intact. The rats in model group (n=24) and PLGA/PEG group (n=24) were treated with the method of mechanical injury of the cecal serosa in order to establish the intraperitoneal adhesion models; then the PLGA/PEG electrospun polymer membrane was used to cover the wound in PLGA/PEG group, but was not in the model group. The intraperitoneal adhesion in PLGA/PEG group and model group were observed at 3 days, 1 week, 2 weeks, and 8 weeks after operation, and the adhesion degree was assessed according to the self-generated standard. The degradation of PLGA/PEG electrospun polymer membrane was also observed in PLGA/PEG group. At each time point, the rats were harvested for histological observation. All the above indexes were compared with the control group.ResultsUsing the electrospinning technology, PLGA/PEG electrospun polymer membrane was prepared successfully. PLGA/PEG electrospun polymer membrane was white and opaque, with soft texture. Scanning electron microscopy observation showed that PLGA/PEG electrospun polymer membrane was mainly composed of disorderly staggered fibers, with microporous structure. All rats survived to the end of the experiment. Gross observation showed that PLGA/PEG electrospun polymer membrane gradually degraded after implantation in vivo, and the adhesion degree in PLGA/PEG group was significantly lower than that in model group (P<0.05), but it had not yet reached to the level of the control group (P<0.05). Histological observation showed that the proliferation of cecal fibrous connective tissue was slower in PLGA/PEG group than in model group, and adhesion severity significantly decreased, only with a small amount of inflammatory cell infiltration. Nevertheless, it was not up to the level of the control group.ConclusionPLGA/PEG electrospun polymer membrane can effectively prevent postoperative intraperitoneal adhesion of rat, and has good biodegradability.
Objective To observe effect of self-designed drug-loaded nanofilm in preventing postoperative peritoneal cavity adhesion during cholecystectomy in New Zealand white rabbit. Methods The 40 New Zealand white rabbits were randomly divided into blank control group, chitosan group, nanofilm group, and drug-loaded nanofilm group using random number table, the peritoneal cavity adhesions after cholecystectomy at different time (on day 7, 14, 21, and 28) were observed among these 4 groups. Results The adhesion of gallbladder forssa was serious in the blank control group and the adhesion situation had obviously improved among the other three groups, furthermore, the adhesion of the drug-loaded nanofilm group was the slightest. The adhesion score was significantly decreased in the chitosan group, the nanofilm group, or the drug-loaded nanofilm group as compared with the blank control group (P<0.05), which in the drug-loaded nanofilm group was significantly decreased as compared with the chitosan group (P<0.05) or the nanofilm group (P<0.05), which had no significant difference between the chitosan group and the nanofilm group (P>0.05). The nanofilm was degraded on day 14 after surgery and basically completely degraded on day 28 after surgery. The nanofilm degradation points had no significant differences between the nanofilm group and the drug-loaded nanofilm group at different time (P>0.05). Conclusions Drug-loaded nanofilm could prevent postoperative peritoneal cavity adhesion from physical barrier and drug therapy. It provides a new idea for prevention of peritoneal cavity adhesion after general surgery and research and development of new material to prevent peritoneal cavity adhesion in future.