天然多糖预防腹膜手术后粘连作用

Natural polysaccharide in the prevention of postoperative abdominal adhesion

目的:腹膜手术作为最常见的外科手术,其术后粘连是一个普遍存在、始终无法彻底解决的问题。就天然多糖在防止腹膜术后粘连中的应用进展、存在的问题以及解决方法进行归纳,对天然多糖的应用前景作出展望。资料来源:应用计算机检索PUBMED1991-01/2006-04期间的相关文章,检索词为“adhesion”,并限定文章语言种类为English。同时计算机检索万方数据库1991-01/2006-04期间的相关文章,检索词为“术后粘连,防粘连”,并限定文章语言种类为中文。资料选择:对资料进行初审,并查看每篇文献后的引文。纳入标准:文章所述内容应与天然多糖防止腹膜术后粘连研究相关。排除标准:重复研究或Meta分析类文章。资料提炼:共收集到525篇相关文献,132篇文献符合纳入标准,排除的393篇文献为内容陈旧或重复。符合纳入标准的132篇文献中,86篇涉及防腹膜术后粘连的方法,46篇涉及天然多糖作为防粘连材料。本文选用其中的39篇作为参考文献。资料综合:腹膜术后粘连引发的严重后果,已使防粘连材料和方法研究的发展成为需要。在诸多防粘连方法中,将天然多糖作为生物屏障物防粘连表现出极大的优越性。本文对文献加以综述,总结右旋糖酐、肝素、氧化再生纤维素、几丁糖、透明质酸、羧甲基纤维素等天然多糖在防腹膜术后粘连领域的应用研究。在不同场合,这些天然多糖各有其优缺点;但是随着对碳水化合物研究的发展,并由市场上已有的防粘连产品比较已得知:几丁糖、透明质酸、羧甲基纤维素具有更广阔的研究潜力,且它们之间的共混或交联等具有更好的防粘连效果。结论:相对于其他防粘连材料,天然多糖具有良好相容性、降解性等优点,其理论研究成果和相关产品的出现显示其巨大前景。为了更好的实现天然多糖在防腹膜术后粘连中的效果,需要对其性质和作用机制作进一步分析。

OBJECTIVE： Postoperative adhesion after abdominal surgery, which is the most common in daily life, is a widespread, irresoluble problem. The applications of natural polysaccharide on the prevention of postoperative abdominal adhesion in recent years were reviewed. Some existing problems and relevant solvents were mentioned, and the prospects of natural polysaccharide in this field have also been predicted. DATA SOURCES： By using the keyword of ＂adhesion＂, a computerbased online search of Pubmed database was undertaken to identify relevant articles on the application of natural polysaccharides on postoperative adhesion prevention after abdominal surgery published in English from January 1991 to April 2006. Meanwhile, Chinese relevant articles published between January 1999 and April＇2006 were searched in Wanfang database with the keyword ＂postoperative adhesion, adhesion prevention＂ in Chinese. STUDY SELECTION： All articles were selected firstly and their quotations were examined. Inclusive criteria： All articles were relevant to the study of natural polysaccharide on postoperative adhesion prevention. Exclusive criteria： The duplicated study or articles about Meta-analysis. DATA EXTRACTION： Totally 525 articles were collected, and 132 of them were included according to the inclusive criteria. The other 393 articles were removed for their duplications and dated contents. There were 86 articles on postoperative adhesion prevention methods and 46 articles about natural polygaccharide as the adhesion prevention materials. Finally 39 articles were selected as references. DATA SYNTHESIS： Due to the serious sequences generated by postoperative abdominal adhesion, the study development of prevention materials and methods have become a necessary. Among several adhesion prevention methods, natural polysaccharide shows its great advantage as a bioresorbable barrier. All selected articles and relevant information were summarized in this paper. The advance of natural polysaccharides, such as dextran, heparin, oxidized regenerated cellulose, chitosan, hyaluronic acid and carbexymethyl cellulose in the prevention field were also mentioned. They have their respective advantages and disadvantages on the different occasions. Now the comparisons of adhesion prevention products on the market, along with the development of the carbohydrate, have approved that chitosan, hyaluronic acid and carbexymethyl cellulose have more expansive potentials than others, and it should achieve better effects on preventing abdominal adhesion when they were blended or cross-linked. CONCLUSION： Compared with other adhesion prevention materials, natural polysaccharide has better biocompatibility and biodegradability. And its theory study progress and relevant products display its great prospects. For the more effective application in the field of postoperative abdominal adhesion prevention, it requires to make more investigations about the property and mechanism of polysaccharides.