Use of bioresorbable membrane (sodium hyaluronate + carboxymethylcellulose) after controlled bowel injuries in a rabbit model
Use of bioresorbable membrane (sodium hyaluronate + carboxymethylcellulose) after controlled bowel injuries in a rabbit model
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在兔模型中控制性肠损伤后使用生物可吸收膜（透明质酸钠羧甲基纤维素）
DOI：
10.1007/bf02236979
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发表时间：
2000
影响因子：
3.9
通讯作者：
V. Lee Billotti
中科院分区：
文献类型：
--
作者：
H. Moreira;S. Wexner;Takuya Yamaguchi;A. Pikarsky;Jeong;E. Weiss;J. Nogueras;T. Cristina Sardinha;V. Lee Billotti
目的：进行肠粘连松解术的患者存在粘连复发和粘连松解术期间损伤的高风险。因此，本研究旨在评估肌切开术和肠切开术后透明质酸钠生物可吸收膜（Seprafilm®）的安全性。方法：共60只家兔接受剖腹手术，平均分配到三组之一：三个修复，或三个未修复的肌切开术，或三个修复的肠切开术。因此，在相同的解剖位置共创建了180个缺损。每组中一半动物的肌切开术或肠切开术表面被Seprafilm®覆盖。十四天后，Seprafilm®完全吸收后，由对Seprafilm®使用不知情的外科医生通过标准放射学等压对比研究评估腹腔内脓肿、粘连的存在和缝合线的完整性。采用Fisher精确检验进行统计学分析，显著性设为P <0.05。研究结果：吻合组粘连发生率为2（6.6%）和9 Seprafilm®和对照组中为30%（非Seprafilm ®）组（P<0.05），未修复组2（6.6%）和10 Seprafilm®和对照组分别为33%在肠切开术组中，Seprafilm®和对照组分别为28例（94%）和29例（97%）（P=不显著）。在肌切开术组中，Seprafilm®部位发生了1例肌纤维瘤（1.6%（1/60）vs.0%，P=不显著）。该组中没有泄漏。在肠切开术组中，Seprafilm®组的排便发生率为33%（10/30），而非Seprafilm ®组为27%（8/30）（P=不显著）。Seprafilm®组和非Seprafilm ®组的渗漏发生率分别为6.6%（2/30）和10%（3/30）（P=不显著）。结论：在肌切开部位使用Seprafilm®可显著降低粘连发生率。肠切开部位的有效性可能因更大的炎症反应而减弱。重要的是，Seprafilm®不会增加任何组的脓毒性死亡率。
PURPOSE: Patients in whom enterolysis is performed are at high risk for recurrence of adhesions and for injury during adhesiolysis. Therefore, the aim of this study was to assess the safety of sodium hyaluronate-based bioresorbable membrane (Seprafilm®) after myotomy and enterotomy. METHODS: A total of 60 rabbits underwent laparotomy with equal distribution to one of three groups: creation of either three repaired, or three unrepaired myotomies, or three repaired enterotomies. Thus, a total of 180 defects were created in the same anatomic positions. One-half of the animals in each group had the surface of the myotomies or enterotomies covered by Seprafilm®. Fourteen days later, after complete absorption of Seprafilm®, the presence of intra-abdominal abscess, adhesions, and the integrity of the suture line were evaluated by a surgeon blinded to the use of Seprafilm®and by a standard radiographic isobaric contrast study. Statistical analysis was done by use of Fisher's exact test; significance was set atP<0.05. RESULTS: The incidence of adhesions in the repaired myotomy group were 2 (6.6 percent) and 9 (30 percent) in the Seprafilm®and control (nonSeprafilm®) groups, respectively (P<0.05); in the unrepaired myotomy group, 2 (6.6 percent) and 10 (33 percent) in the Seprafilm®and control groups, respectively (P<0.05); and in the enterotomy group, 28 (94 percent) and 29 (97 percent) in the Seprafilm®and control groups, respectively (P= not significant). A single phlegmon occurred in the myotomy group at a Seprafilm®site (1.6 (1/60)vs.0 percent,P= not significant). There were no leaks in this group. In the enterotomy group, the incidence of phlegmons was 33 percent (10/30) in the Seprafilm®group, whereas it was 27 percent (8/30) in the nonSeprafilm®group (P= not significant). The incidence of leaks was 6.6 (2/30) and 10 percent (3/30) in the Seprafilm®and nonSeprafilm®group, respectively (P= not significant). CONCLUSION: The use of Seprafilm®at the sites of myotomies significantly reduced the incidence of adhesions. Effectiveness at the enterotomy site may have been attenuated by a greater inflammatory response. Importantly, Seprafilm® did not increase septic mortality in any group.