CAJ | 학술논문

背景：开腹手术后常造成腹膜粘连，给患者带来极大的痛苦，至今仍没有发现一种有效的药物或方法能够完全预防腹膜粘连，羧甲基壳聚糖是具有优良生物相容性和生物降解性，是理想的预防腹腔粘连的生物材料。目的：研究羧甲基壳聚糖防粘连冲洗液预防大鼠术后腹膜粘连的效果，探讨其防粘连的作用机制。 　　方法：取56只成年雄性Wistar大鼠建立盲肠刮伤/腹壁缺损的动物手术模型，随机分为4组，分别以生理盐水、医用透明质酸、医用几丁糖和羧甲基壳聚糖防粘连冲洗液涂布于盲肠刮伤面及腹壁缺损处。术后2，3周进行粘连分级和病理组织观察，同时测定转化生长因子β1表达、血液中白细胞数量及羟脯氨酸含量。 　　结果与结论：透明质酸组、几丁糖组粘连分级评分结果优于生理盐水组(P <0.05)，羧甲基壳聚糖组粘连分级评分结果明显优于生理盐水组(P <0.01)。血常规、苏木精-伊红染色和转化生长因子β1免疫组织化学染色结果显示，羧甲基壳聚糖防粘连冲洗液与医用透明质酸和医用几丁糖一样具有较好的组织相容性，可通过降低转化生长因子β1的表达、减少羟脯氨酸的合成，抑制腹腔粘连发生的程度和范围。
배경：개복수술후상조성복막점련，급환자대래겁대적통고，지금잉몰유발현일충유효적약물혹방법능구완전예방복막점련，최갑기각취당시구유우량생물상용성화생물강해성，시이상적예방복강점련적생물재료。목적：연구최갑기각취당방점련충세액예방대서술후복막점련적효과，탐토기방점련적작용궤제。 　　방법：취56지성년웅성Wistar대서건립맹장괄상/복벽결손적동물수술모형，수궤분위4조，분별이생리염수、의용투명질산、의용궤정당화최갑기각취당방점련충세액도포우맹장괄상면급복벽결손처。술후2，3주진행점련분급화병리조직관찰，동시측정전화생장인자β1표체、혈액중백세포수량급간포안산함량。 　　결과여결론：투명질산조、궤정당조점련분급평분결과우우생리염수조(P <0.05)，최갑기각취당조점련분급평분결과명현우우생리염수조(P <0.01)。혈상규、소목정-이홍염색화전화생장인자β1면역조직화학염색결과현시，최갑기각취당방점련충세액여의용투명질산화의용궤정당일양구유교호적조직상용성，가통과강저전화생장인자β1적표체、감소간포안산적합성，억제복강점련발생적정도화범위。
BACKGROUND:The patients are suffering from peritoneal adhesions that are caused after abdominal operation. As so far, there is stil no effective drug or method that can completely prevent peritoneal adhesions. Carboxymethyl chitosan is a biocompatible and biodegradable biomedical material with anti-adhesion effects, which is an ideal biomaterial for prevention of peritoneal adhesion theoreticaly. OBJECTIVE:To investigate the novel anti-adhesion properties of carboxymethyl chitosan anti-adhesion solution on the prevention of postsurgical adhesion in vivo in a rat model. METHODS:Fifty-six adult male Wistar rats were randomly divided into four groups: 0.9% normal saline solution (group A), hyaluronic acid gels (group B), medical chitosan gels (group C) and carboxymethyl chitosan anti-adhesion solution (group D). The model of postoperative intestinal adhesion was established by making cecal scratches/abdominal wal defects. Al the rats were scarified after 2 or 3 weeks. Whole blood was colected by cardio-puncture, lung tissue and tissue adhesion were stripped. The incidence and degree of adhesions, histological effects, expression of transforming growth factor-β1 (TGF-β1), the amounts of hydroxyproline and white blood cels were observed. RESULTS AND CONCLUSION:The formation of postsurgical adhesions in groups B, C and D was significantly decreased, which was lighter than that of group A (P < 0.05). Furthermore, the adhesion formation in group D was significantly decreased in comparison with group A (P < 0.01). At the same time, the levels of transforming growth factor-β1, hydroxyproline and white blood cels in group D were lighter than those of group A (P < 0.05), and the histopathological results indicated that a marked reduction in inflammatory cels and fibroblasts. Carboxymethyl chitosan anti-adhesion solution can effectively reduce the degree and incidence of postoperative adhesion, and it is becoming a promising drug delivery system in the context of postsurgical anti-adhesion.