CAJ | 학술논문

目的观察医用防粘连改性壳聚糖膜预防腹部手术后腹腔粘连的临床效果.方法选用天津医科大学总医院外科2007年1月至2011年2月86例左侧大肠癌伴急性完全性肠梗阻行肿瘤切除、近端结肠造瘘的患者,数字表随机分为对照组和试验组,各43例.试验组关闭腹腔时在手术创面和切口下放置改性壳聚糖膜,对照组不放置并常规关腹.观察术后胃肠道恢复情况、腹痛程度和持续时间,随访术后发生肠梗阻的例数,并在术后3～6个月内行二期造瘘还纳时评估腹腔粘连程度,取部分后腹膜及粘连组织测定羟脯氨酸水平.结果试验组患者腹痛症状较对照组明显轻,术后肠道运动功能恢复更快,进食时间更早[(3.3±1.0)比(4.2±1.1)d,P＜0.05],术后发生粘连性肠梗阻的例数明显少于对照组[1(2.3％)比4(9.3％),P＜0.05].试验组粘连分级和粘连发生率较对照组明显轻,试验组粘连组织羟脯氨酸水平明显低于对照组,差异有统计学意义[(0.832±0.071)比(1.375±0.108) μg/mg蛋白,P＜0.05].结论医用防粘连改性壳聚糖膜可以有效地防止腹部手术后的腹腔粘连,降低粘连性肠梗阻的发生率.
목적 관찰의용방점련개성각취당막예방복부수술후복강점련적림상효과.방법 선용천진의과대학총의원외과2007년1월지2011년2월86례좌측대장암반급성완전성장경조행종류절제、근단결장조루적환자,수자표수궤분위대조조화시험조,각43례.시험조관폐복강시재수술창면화절구하방치개성각취당막,대조조불방치병상규관복.관찰술후위장도회복정황、복통정도화지속시간,수방술후발생장경조적례수,병재술후3～6개월내행이기조루환납시평고복강점련정도,취부분후복막급점련조직측정간포안산수평.결과 시험조환자복통증상교대조조명현경,술후장도운동공능회복경쾌,진식시간경조[(3.3±1.0)비(4.2±1.1)d,P＜0.05],술후발생점련성장경조적례수명현소우대조조[1(2.3％)비4(9.3％),P＜0.05].시험조점련분급화점련발생솔교대조조명현경,시험조점련조직간포안산수평명현저우대조조,차이유통계학의의[(0.832±0.071)비(1.375±0.108) μg/mg단백,P＜0.05].결론 의용방점련개성각취당막가이유효지방지복부수술후적복강점련,강저점련성장경조적발생솔.
Objective To explore the preventive effects of modified chitosan medical anti-adhesion membrane on postoperative intra-abdominal adhesion.Methods A total of 86 patients with obstructive colorectal carcinoma undergoing emergent colostomy and second-stage anastomosis were randomly divided into 2 groups (n =43 each).In the research group modified chitosan medical anti-adhesion membrane were put both at the area of operation and under the incision before abdomen closing,but not so in the control group.The recovery procedures were recorded including gut movement,degree and duration of abdominal pain and cases of adhesive ileus.During the reopening of abdominal cavities 3 to 6 months later,intestinal anastomosis was performed.And adhesive severity was graded blindly and the level of hydroxyproline measured within injured posterior peritoneum and adhesive tissue.Results As compared with the control,postoperative abdominal pain was weaker; the recovery of gut motor function and eating better ((3.3 ± 1.0)vs(4.2±1.1)days,P＜0.05),the incidence of adhesive ileus lower (1(2.3％) vs4(9.3％),P＜0.05),adhesion significantly lighter and the hydroxyproline level lower ((0.832 ± 0.071) vs (1.375 ±0.108) μg/mg protein,P ＜ 0.05) in the research group.Conclusion Modified chitosan medical antiadhesion membrane has preventive effects on postoperative intra-abdominal adhesion so as to decrease the incidence of adhesive ileus.