化学改性壳聚糖膜预防不同类型腹膜粘连的实验研究

Experimental study on the preventive effect of chemically-modified chitosan film on peritoneal adhesion of different types

目的对比研究化学改性壳聚糖膜对四种不同原因所致的大鼠腹膜粘连的预防作用。方法将壳聚糖行化学改性,制成厚60μm的膜消毒后备用。SD大鼠200只,随机分成假手术对照组(A组)、创伤致粘连组(B组)、滑石粉致粘连组(C组)、结扎血管致粘连组(D组)及感染致粘连组(E组)。各组分别用相应的方法来处理大鼠蚓突盲端,再将每组大鼠分成对照组和实验组,对照组大鼠直接关腹,实验组用凝胶化改性壳聚糖膜覆盖蚓突盲端浆膜面,然后关腹。处理后2周和4周后打开腹腔,以Bhatia分级法评定蚓突盲端的粘连程度,并对盲端组织行羟脯胺酸(hydroxyproline,OHP)、组织型纤溶酶原激活剂(tissue-type plasminogen activatior,t-PA)和纤溶酶原激活物抑制因子(plasminogen activator inhibitor,PAI)水平测定,对腹腔液行t-PA、PAI测定。结果①粘连程度和OHP水平:术后2周和4周,B、D、E组中实验组的粘连程度、OHP水平均分别显著低于对照组(P<0.05),而A、C组中的实验组和对照组间差异均无统计学意义(P>0.05);②t-PA、PAI水平:术后2周和4周,A组、C组和D组的蚓突组织和腹腔液t-PA、PAI水平,实验组和对照组间差异均无统计学意义(P>0.05);B组、E组中实验组t-PA水平均显著高于对照组(P<0.05),而PAI水平则显著低于对照组(P<0.05)。结论化学改性壳聚糖膜对创伤、缺血及感染所致的腹膜粘连有明显的预防作用,而对滑石粉所致的腹膜粘连则作用不明显;对不同原因所致的腹膜粘连,可以用来准确衡量组织粘连程度的指标也不尽相同。

Objective To comparatively study the preventive effect of chemically-modified chitosan film on peritoneal adhesions which were induced by four different causes in rats. Methods Chitosan was chemically modified, developed into films of 60 μm in thickness, and sterilized for the following use. 200 Sprague-Daw- Icy rats were randomly divided into five groups, pseudo-operation group （group A）, wound-induced adhesion group （group B）, purifide talc-induced adhesion group （group C）, vascular ligation-induced adhesion group （group D）, and infection-induced adhesion group （group E）, respectively. In each group, the rats were treated with corresponding adhesion-inducing methods at their dital end of vermiform processes and then were divided into control and experimental subgroups. Serous membrane faces of vermiform processes were covered with the films in the experimental subgroups, and no films were used in the control subgroups. After 2 and 4 weeks of the treatments, the abdominal cavities were reopened and the adhesive severity was graded blindly accord- ing to the Bhatia＇s method. The dital end of vermiform processes were resected for hydroxyproline （OHP）, tissue-type plasminogen activator （t-PA） and plasminogen activator inhibitor （PAI） measurements, and the peri- toneal fluid was collected for t-PA and PAI measurements. Results （1）Adhesion severity and OHP level： Af- ter 2 and 4 weeks of the treatments of the experimental subgroups, the adhesions were significantly lighter and the OHP levels were significantly lower than those of the control subgroups in group B, D and E （P〈 0.05）, but there were no significant differences in group A and C （P〉0.05）; （2）t-PA and PAI levels： After 2 and 4 weeks of the treatments of the experimental subgroups, the t-PA levels were significantly higher and the PAI levels were significantly lower than those of the control subgroups in group B and E （P〈0.05）, but there were no significant differences in group A, C and D （P〉0.05）. Conclusion The chemically-modified ehitosan film is effective in preventing peritoneal adhesions induced by wound, ischemia and infection, but the effect is not apparent on the foreign body-induced adhesion. The biochemical indexes for measuring the severity of adhesion should be chosen according to the different causes of peritoneal adhesion.