青霉胺预防腹腔粘连及对刀口抗张力影响的研究

Penicillamine inhibits introabdominal adhesion formation and influence on wound healing

目的:探讨青霉胺对腹腔粘连的预防作用及对刀口愈合的影响。方法:随机将60只昆明小鼠分成A、B、C3组,每组20只。行1.5cm腹正中切口,在右侧腹膜缝植5mm2大小乳胶片,关腹前A组留置生理盐水1ml,B组留置3%青霉胺1ml,C组留置3%青霉胺1ml且术后连续每天口服3%青霉胺1ml。术后10、20d分别处死各组的一半,根据Bigatt's计分法计算每组小鼠粘连发生率和粘连积分,观察刀口愈合情况,行抗张力测试,部分粘连组织行免疫组化染色,观察血管及组织增生情况。结果:术后10d,B、C组粘连发生率低于A组(P<0.05)、粘连积分明显低于A组(P<0.01);术后20d,粘连发生率C组低于A组(P<0.05),粘连积分B、C组明显低于A组(P<0.01)。B、C组刀口均甲级愈合,但抗张力测试低于A组(P<0.01)。结论:青霉胺具有明显预防腹腔粘连的作用,降低刀口抗张力而不影响刀口愈合。

Objective： To explore the efficacy of penicillamine on prohibition of intra-abdominal adhesion and influence on wound healing. Methods： Sixty Kunming mice divided into 3 groups randomly （A, B and C, n=20）, each mouse was made a 1.5 cm peritoneal midline incision and fixed a 5 mm^2 plastisol patch to the right side of the peritoneum. Before suture, mouse was injected with normal saline （1ml） in group A, penicillamine （3%, 1ml） in group B, penicillamine （3%, 1ml） and oral administrated penicillamine （3%, 1 ml/d） in group C. 10 miee in each group were killed 10 and 20 days after treatment. According to Bigatt＇s method, the adhesion rate and score were analysed based on their extent, type and tenacity. Some adhesions were detected by immunohistochemieal method. The breaking strength of belly wall was measured. Results： At postoperative 10 days, the incidence and score of adhesions were less in group B or C than those in group A（P〈0.05）. At postoperative 20 days, the incidence of adhesions was less in group C than that in group A（P〈 0.05）, the adhesion score was less in group B or C than that in group A（P〈0.01 ）. All wounds healed up well, but the wound breaking strength descended in group B and C compared with group A. Conclusions： Penicillamine has great effect to inhibit intra-abdominal adhesion formation and reduce the wound breaking strength, but it has no influence on wound healing.