玻璃酸钠预防术后盆腔黏连的临床研究

Clinical trial of sodium hyaluronate on preventing pelvic adhesions after operation

目的观察玻璃酸钠预防术后盆腔黏连的临床疗效。方法将87例腹盆腔手术患者随机分为对照组43例和试验组44例。2组患者均进行开腹手术治疗。对照组缝合后用无菌医用纱布贴于伤口上;试验组于病灶切除前,在病灶部位内皮对应的腹膜充分涂抹玻璃酸钠,去除病灶后于创面再次涂抹。比较2组患者的黏连发生率、血清白细胞介素-6、肿瘤坏死因子-α、细胞间黏附因子、Ⅲ型前胶原、层黏连蛋白水平。结果术后,试验组的黏连总发生率为6.82%显著低于对照组的23.26%(P<0.05)。2组患者术后血清白细胞介素-6、肿瘤坏死因子-α、胞间黏附因子水平均较术前显著降低,且试验组术后上述指标显著低于对照组(P<0.05),Ⅲ型前胶原、层黏连蛋白水平均较术前显著升高,且试验组术后上述指标显著高于对照组(P<0.05)。结论玻璃酸钠可有效地降低盆腔手术术后的黏连发生率。

Objective To evaluate the clinical efficacy of sodium hyaluronate on preventing pelvic adhesions after operation. Methods Eighty- seven patients with abdominal pelvic surgery were randomly divided into control group（ n = 43） and treatment group（ n = 44）. Two groups were received open abdominal pelvic surgery. After wound closure,control group was affixed the sterile medical gauze to the wound. Before excision lesion,treatment group was coated sodium hyaluronate on corresponding peritoneum for the lesion of endothelial,then the wound was coated again after excision lesion. Adhesion rate,serum levels of interleukin- 6（ IL- 6）,tumor necrosis factor alpha（ TNF- α）,intercellular cell adhesion molecule- 1（ ICAM- 1）,precollagen Ⅲ（ PCⅢ） and laminin（ LN）were compared between two groups. Results After treatment,the total incidence of adhesion rate in treatment group was significantly lower than that in control group（ 6. 82% vs 23. 26%,P〈 0. 05）. After treatment,the serum levels of IL- 6,TNF- α and ICAM- 1 in treatment group were significantly lower than those of control group,the levels of PC Ⅲand LN were significantly higher than those of control group（ P〈 0. 05）.Conclusion Sodium hyaluronate can effectively reduce the incidence of adhesions,and regulate the level of cytokines.