Abdominal Massage for Postoperative Adhesions and Ileus

描述(由申请者提供)：该项目将首次研究腹部按摩(腹部内容物和腹壁的治疗性活动)对预防和治疗术后腹膜粘连和肠梗阻的影响。腹内粘连(腹膜损伤后形成的纤维结缔组织的病理条带)是导致肠梗阻、不孕、慢性疼痛和重复手术的主要原因。尽管粘连可以自发发生，但一个多世纪以来，粘连一直被报道为手术的副作用，发生率高达95%或更高。仅在美国，对术后粘连相关发病率的经济负担的最新估计就达到50亿美元。腹部手术也总是会导致暂时性的肠道功能改变，称为肠梗阻。肠梗阻是术后不适和住院时间延长的重要原因，也给医疗保健服务系统带来了巨大的经济负担。尽管作出了大量努力，但有效的预防和治疗方法对这两种情况仍然不能令人满意。几个世纪以来，腹部按摩方法一直被用来治疗各种腹部不适，据传闻，它还用于治疗粘连和肠梗阻的症状。我们用大鼠模型进行的初步实验得出了这样的假设，即腹部按摩可以防止术后粘连的形成，并减轻术后肠梗阻。测试将解决腹部按摩对以下方面的影响：1)术后肠梗阻。在炎症期和粘连期，盲肠擦伤后的大鼠将接受腹部按摩。胃肠功能、炎症和纤溶系统的分析将在许多终点进行。2)术后粘连形成。在炎症期和粘连期，盲肠擦伤后的大鼠将接受腹部按摩，并允许大鼠存活7天。腹部将被解剖，并对粘连进行定量评估。3)迷走神经传入放电，以及是否需要完整的迷走神经感觉系统才能达到按摩的效果。炎症是肠梗阻和粘连形成的关键，由迷走神经调节。在一组实验中，在腹部按摩过程中，将记录单一迷走神经传入放电特性，并与手术和未手术的大鼠进行比较。在另一项实验中，将在迷走神经去传入的大鼠身上测量腹部按摩对肠梗阻的影响，并与去传入但未治疗的大鼠进行比较。4)大鼠结肠狭窄成形术的愈合。将对两组大鼠进行巩膜成形术，其中一组将接受按摩。7天后，将对手术段的结肠进行承受腔内压力的能力测试。术后是否存在粘连也将进行评估。

DESCRIPTION (provided by applicant): This project will be the first to examine the effects of abdominal massage (therapeutic mobilization of the abdominal contents and wall) on the prevention and treatment of postoperative peritoneal adhesions and ileus. Intra-abdominal adhesions (pathological bands of fibrous connective tissue that develop after peritoneal injury) are a leading cause of bowel obstruction, infertility, chronic pain, and repeated surgeries. Although they can occur spontaneously, adhesions have been reported as an adverse side effect of surgery for over a century, occurring at a rate of 95% or higher. The most recent estimate of the economic burden of the associated morbidity of postoperative adhesions is $5 billion in the United States alone. Abdominal surgery also invariably causes a temporary alteration of intestinal function, called ileus. Ileus is an important cause of postoperative discomfort and prolonged hospital stay, and also places a huge financial burden on the health care delivery system. Despite substantial efforts, effective prevention and treatment methodologies remain unsatisfactory for both of these conditions. Methods of abdominal massage have been used for centuries to treat various abdominal complaints, and are anecdotally reported to treat symptoms of adhesions and ileus. Our preliminary experimentation using rat models has led to the hypotheses that abdominal massage prevents postoperative adhesion formation, and attenuates postoperative ileus. Testing will address the effect of abdominal massage on: 1) postoperative ileus. Abdominal massage will be performed on rats following cecal abrasion throughout the inflammatory and adhesiogenic periods. Assays of gastrointestinal function, inflammation, and the fibrinolytic system will be performed at numerous endpoints. 2) postoperative adhesion formation. Abdominal massage will be performed on rats following cecal abrasion throughout the inflammatory and adhesiogenic periods, and the rat allowed to survive for 7 days. The abdomens will be dissected and quantitatively evaluated for adhesions. 3) vagal afferent discharge, and whether an intact vagal sensory system is necessary for the effects of massage. Inflammation is key to both ileus and adhesion formation, and is modulated by the vagus nerve. In one set of experiments, unitary vagal afferent discharge properties will be recorded during abdominal massage, comparing operated to unoperated rats. In a separate experiment, the effect of abdominal massage on ileus will be measured in vagal-deafferented rats, and compared to deafferented but untreated rats. 4) the healing of a rat colonic strictureplasty. Strictureplasty will be performed on two groups of rats, one of which will receive massage. After 7 days, the operated section of colon will be tested for the ability to withstand intraluminal pressure. The presence of postoperative adhesions will also be evaluated.