Attenuation of postoperative adhesions using a modeled manual therapy.
Attenuation of postoperative adhesions using a modeled manual therapy.
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DOI：
10.1371/journal.pone.0178407
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Mokler DJ
中科院分区：
文献类型：
--
作者：
Bove GM;Chapelle SL;Hanlon KE;Diamond MP;Mokler DJ
术后粘连是指手术后发生在腹盆结构之间的病理性粘连。术后粘连被认为是不可避免的和普遍存在的，它会导致肠梗阻、不孕、疼痛和再次手术。因此，它们是一项重大的卫生保健挑战。尽管经过了世纪的研究，仍然没有预防性治疗。我们假设，术后粘连的发生是由于手术和阿片类药物使腹腔盆腔器官在术后即刻无法移动，并测试了手动治疗是否会阻止其发生。在改良的大鼠盲肠磨损模型中，将大鼠分配接受手动治疗或不接受治疗，并量化其产生的粘连。我们还表征了巨噬细胞表型。在单独的实验中，我们测试了狭窄成形术模型治疗的安全性，以及粘连松解术后治疗的有效性。我们表明，治疗导致减少的频率和大小的粘性粘连，但不是其他类型的粘连，如那些涉及腹腔内脂肪结构。这种效应与营养性巨噬细胞的出现延迟有关。治疗不会抑制愈合或诱发狭窄成形术后的不良并发症。我们的研究结果支持，在术后早期保持受损结构的运动有可能作为一种有效的预防措施，减少术后粘连的发展。我们的发现为进一步的研究奠定了基础，包括在愈合过程中保持运动的机械和药理学方法。
Postoperative adhesions are pathological attachments that develop between abdominopelvic structures following surgery. Considered unavoidable and ubiquitous, postoperative adhesions lead to bowel obstructions, infertility, pain, and reoperations. As such, they represent a substantial health care challenge. Despite over a century of research, no preventive treatment exists. We hypothesized that postoperative adhesions develop from a lack of movement of the abdominopelvic organs in the immediate postoperative period while rendered immobile by surgery and opiates, and tested whether manual therapy would prevent their development. In a modified rat cecal abrasion model, rats were allocated to receive treatment with manual therapy or not, and their resulting adhesions were quantified. We also characterized macrophage phenotype. In separate experiments we tested the safety of the treatment on a strictureplasty model, and also the efficacy of the treatment following adhesiolysis. We show that the treatment led to reduced frequency and size of cohesive adhesions, but not other types of adhesions, such as those involving intraperitoneal fatty structures. This effect was associated with a delay in the appearance of trophic macrophages. The treatment did not inhibit healing or induce undesirable complications following strictureplasty. Our results support that that maintained movements of damaged structures in the immediate postoperative period has potential to act as an effective preventive for attenuating cohesive postoperative adhesion development. Our findings lay the groundwork for further research, including mechanical and pharmacologic approaches to maintain movements during healing.