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目的对比研究凝胶化改性壳聚糖膜和透明质酸钠对腹膜粘连的预防作用。方法SD大鼠80只,随机分成4组:假手术对照组(A组),生理盐水对照组(B组),凝胶化改性壳聚糖膜组(C组),透明质酸钠组(D组)。利用大鼠蚓突盲端制作创伤性腹膜粘连模型,然后每组分别用相应的方法处理创面,处理后第2周和第4周打开腹腔,以Bhatia分级法评定蚓突盲端的粘连程度,并对盲端组织行羟脯胺酸(OHP)水平测定和病理组织学检查。结果术后第2周和第4周,C,D组的粘连程度均显著轻于B组(P=0.001~0.013),OHP水平显著低于B组(P=0.037~P<0.001);C组和D组比较,粘连程度分级的差异两组间无显著性意义(P>0.05),但OHP含量C组显著低于D组(P=0.005,0.002)。病理学检查:A组所有大鼠蚓突组织无明显的病理改变,B组术后第2周时处理侧浆膜面有明显的炎症细胞浸润和纤维组织增生,术后第4周局部主要以纤维组织增生为主;相应的病理改变C,D组较B组明显减轻,C组的病理改变又明显轻于D组。结论凝胶化改性壳聚糖膜具有明显的抗腹膜粘连作用,且此作用较透明质酸钠具有优势。
Objective To compare the preventive effect of gelatinized chitosan membrane and sodium hyaluronate on peritoneal adhesion. Methods Eighty SD rats were randomly divided into 4 groups: sham operation control group (A group), saline control group (B group), gelatinized modified chitosan membrane group (C group), sodium hyaluronate group (Group D). The traumatic peritoneal adhesion model was made by using the earthworm of rats. The wounds were treated with corresponding methods in each group. The abdominal cavity was opened at the second week and the fourth week after treatment. The degree of adhesion of the earthworm was evaluated by Bhatia grading Hydroxyproline (OHP) levels and histopathological examination of the blind side were performed. Results The adhesion of C and D groups were significantly lighter than those of B group (P = 0.001-0.013) at 2 weeks and 4 weeks after operation, and the levels of OHP in C and D groups were significantly lower than those in B group (P = 0.037 ~ P <0.001) There was no significant difference between groups (P> 0.05), but OHP content in group C was significantly lower than that in group D (P = 0.005, 0.002). Pathological examination: All the rats in group A had no obvious pathological changes in the pathological changes of the earthworms, and in the second week after the operation in group B, obvious inflammatory cell infiltration and fibrous tissue hyperplasia were observed in the serous surface. In the fourth week after operation, Fibrous tissue hyperplasia; corresponding pathological changes in C, D group was significantly reduced compared with B group, C group of pathological changes was significantly lighter than the D group. Conclusion Gel-modified chitosan membrane has obvious anti-peritoneal adhesion, and this effect has advantages over sodium hyaluronate.