壳聚糖凝胶对大鼠腹膜粘连的预防作用

Preventive effects of chitosan gel on peritoneal adhesions in rats

目的 :探讨壳聚糖凝胶对三种不同原因所致的大鼠腹膜粘连的预防作用。方法 :14 4只SD大鼠 ,随机分成创伤致粘连组 (A组 )、滑石粉致粘连组 (B组 )及结扎血管致粘连组 (C组 )。各组分别用相应的致粘连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 ,实验组用壳聚糖凝胶均匀涂布于经处理的蚓突浆膜面 ,然后关腹。处理后 2w、4w再次打开腹腔 ,肉眼评定蚓突盲端同其周围组织的粘连程度 ,并取蚓突盲端组织行病理组织学检查。结果 :①粘连评定 :术后 2w和 4w ,A组和C组中实验组的粘连程度均分别显著低于对照组 (P <0 .0 5或P <0 .0 1) ,而B组中的实验组和对照组间均无明显差异 (P >0 .0 5 )。②病理改变 :A组处理侧浆膜面以纤维组织增生为主 ,而C组蚓突全层均有纤维组织增生 ,以浆膜层为重。B组处理侧浆膜面有大量异物巨细胞反应及肉芽肿形成 ,并伴有程度不同的纤维组织增生。结论 :壳聚糖凝胶对创伤及缺血所致的腹膜粘连有明显的预防作用 ,而对异物所致的腹膜粘连作用则不明显。

Objective:To comparatively study the preventive effect of chitosan gel on peritoneal adhesions which were resulted from three different causes in rats.Methods:144 Sprague Dawley rats were randomly divided into three groups,wound resulting adhesion group(group A),purified talc resulting adhesion group(group B) and vascular ligation resulting adhesion group(group C),respectively. In each group,the rats were treated with corresponding adhesion resulted methods at their caecums of vermiform processes and then were divided into control group and experimental group. Serous membranous surfaces of vermiform processes were smeared with chitosan gel and then abdominal cavities were closed in the experimental group,but in the control group,the abdominal cavities were directly closed without use of chitosan gel. After two and four weeks of the treatments, the abdominal cavities were reopened and the adhesions were graded blindly according to their severity,and the caecums of vermiform processes were resected for light microscopy examination.Results:①Adhesion evaluation:at two and four weeks after treatments,the adhesions of experimental groups were severer than that of control groups in group A and group C(P<0.05 or P<0.01),but there were no significant differences in group B(P>0.05).②Pathological changes:in group A,the main pathological changes were fibroplasias in the treated serous membranous surfaces and in group C,the fibroplasias displayed in whole layer of the vermiform processes with the severest changes in serous membranes. In group B,the main changes were foreign body giant cell and granuloma reactions and fibroplasias in different degrees.Conclusion:The chitosan gel is effective on preventing peritoneal adhesions resulted from wound and ischemia,but the effect is not apparent on the foreign body resulting adhesions.