羧甲基壳聚糖预防兔手术后粘连的效果:大体和病理学大样本观察

Prevention of Postoperative Adhesions with N,O-carboxymethyl Chitosan in Rabbit:A Large-sample Gross and Histopathological Observation

目的评价羧甲基壳聚糖(N,O-carboxymethyl chitosan,NOCC)预防兔手术后粘连的效果。方法 220只雌性大耳白兔采用双子宫模型造成手术粘连,随机分组后接受单纯造模手术(对照组)或造模手术+关腹前腹腔内注射NOCC(NOCC组)。所有手术均由同一位术者完成。每组各22只大耳白兔在实验设计的5个观察时间点(术后3、7、14、28和42 d)分别被处死并评估其粘连情况,包括范围、类型和强度等大体情况和炎症、纤维化以及新生血管等镜下情况。结果 NOCC组在术后3 d时其粘连的范围(P=0.0337)和强度(P=0.0271)以及炎症反应情况(P<0.0001)均显著轻于对照组。在术后14 d内,NOCC组的纤维化情况均明显轻于对照组(P均<0.0005)。与对照组相比,NOCC组的粘连强度在术后14、28、42 d均明显减轻(P均<0.05),而其粘连类型评分在术后28和42 d也明显降低(P均<0.05)。结论经NOCC处理后,兔盆腹腔术后粘连大体和病理学评分均不同程度降低。应用NOCC可有效预防盆腹腔术后粘连。

Objective To assess the effect of N , O-carboxymethyl chitosan （ NOCC） in preventing post-operative adhesion in a rabbit model. Methods Double uterine horn model was established in 220 female rabbits to induce postoperative adhesion. The rabbits were randomized to receive either adhesion-inducing operation only （ control group） or adhesion-inducing operation ＋ intraperitoneal in jec t io n of NOCC before closure （ NOCC group） . Al l the operations were performed by one operator. Twenty-two rabbits from each group were euthanized at one o f the five different time points （ postoperative day 3 , 7 , 14 , 28 , and 42）, and adhesion formation was scored both grossly （ e x te n t, ty p e , and te n a c ity） and histopathologically （ in -flammation , fibrosis, and vascularizat ion） . Results The extent （ P = 0. 0337 ） and tenacity o f adhesion （P = 0. 0271） as well as inflammation （ P 〈 0. 0001 ） were lower in the NOCC group than in the control group on day 3. Fibrosis was less obvious in the NOCC group compared to the control group （P 〈 0. 0005） before day 14. The tenacity scores of adhesion on day 14 , 28 , and 42 were s ig nif ica nt ly lower in the NOCC group than in the control group （ all P 〈 0. 05 ） , w h ile the type scores were obviously lower in the NOCC group on day 28 and 42 （ all P 〈 0. 05 ） . Conclusions Treatment with NOCC could reduce both gross and histopathological scores of surgery-induced abdominopelvic adhesions in ra b b its. NOCC could be an effective therapy for preventing postoperative abdominopelvic adhesion.