各种防粘连产品对腹壁肌肉愈合的影响

Effect of anti-adhesion products on the healing of abdominal muscles

目的评价目前主要防粘连产品对腹壁肌肉愈合的影响,为临床使用防粘连产品提供指导。方法实验使用成年SD大鼠,除假手术组外,对大鼠盲肠及相对腹壁肌肉制造损伤,然后不使用(粘连组)或使用不同防粘连产品覆盖损伤处,手术14 d后,检测大鼠腹壁肌肉力学性质和组织学特征,评价损伤肌肉愈合程度。结果聚乳酸医用膜组和医用聚乙二醇小檗碱液组腹壁肌肉愈合侧的最大抗张力和刚度均与正常侧相近(P>0.05);医用几丁糖组和Seprafilm组愈合侧的最大抗张力明显低于正常侧(P<0.05),刚度则不存在显著差异(P>0.05);粘连组和医用透明质酸钠凝胶组腹壁肌肉愈合侧的力学性质明显小于正常侧(P<0.05)。HE染色显示,医用透明质酸钠凝胶、聚乳酸医用膜和医用聚乙二醇小檗碱液组血管增生较多;透明质酸钠凝胶组的纤维结构松散,炎性细胞浸润不均匀,其他产品组炎性细胞浸润充分,且纤维形成致密。结论聚乳酸医用膜和医用聚乙二醇小檗碱液促进腹壁肌肉愈合的能力优于医用透明质酸钠凝胶、医用几丁糖和Seprafilm。

Objective To evaluate the effect of commonly used anti-adhesion products on the healing of abdominal muscles, and to provide guidance for surgeons to use anti-adhesion products in their clinical practice. Methods Adult SD rats were used. Except the sham group, surgical traumas were created on the serosal layer of the ce- cum and the underlying muscles of the abdominal wall. The wounds were covered without （Adhesion group） or with anti-adhesion products. Fourteen days after the surgery, the mechanical properties and histology of abdomi- nal muscles were investigated to evaluate the healing of injured muscles. Results The ultimate tensile force and stiffness of the healing abdominal muscles in the groups of Polylactic acid membrane and Medical polyethylene glycol berberis lye were the same as those of normal muscles （ P 〉 0.0,5）. The ultimate tensile force of the heal- ing muscle in the groups of Chitosan gel an_d Seprafilm was significantly smaller than that of normal muscles （ P 〈 0.0,5）. But their stiffness did not show any significant differences （ P 〉 0.05）. The significant losses of me- chanical properties of the healing muscles occurred in the Adhesion and Medical sodium hyaluronate gel group （P 〈 0.0,5）. HE staining indicated that more capillaries were found in Medical sodium hyaluronate gel, Polylactic acid membrane and Medical polyethylene glycol berberis lye group. The wound in Medical sodium hyaluronate gel group had less fibroblasts and fewer inflammatory cells, while the inflammatory cells were fully infiltrated with dense fibers in the other product groups. Conclusions Polylactic acid membrane and Medical polyethylene glycol berberis lye can promote abdominal muscle healing and are superior to Medical sodium hyaluronate gel, Chitosan gel and Seprefilm.