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羧甲基壳聚糖预防兔手术后粘连的效果:大体和病理学大样本观察

任常 赵大春 朱兰

任常, 赵大春, 朱兰. 羧甲基壳聚糖预防兔手术后粘连的效果:大体和病理学大样本观察[J]. 协和医学杂志, 2016, 7(5): 347-352. doi: 10.3969/j.issn.1674-9081.2016.05.005
引用本文: 任常, 赵大春, 朱兰. 羧甲基壳聚糖预防兔手术后粘连的效果:大体和病理学大样本观察[J]. 协和医学杂志, 2016, 7(5): 347-352. doi: 10.3969/j.issn.1674-9081.2016.05.005
Chang REN, Da-chun ZHAO, Lan ZHU. Prevention of Postoperative Adhesions with N, O-carboxymethyl Chitosan in Rabbit: A Large-sample Gross and Histopathological Observation[J]. Medical Journal of Peking Union Medical College Hospital, 2016, 7(5): 347-352. doi: 10.3969/j.issn.1674-9081.2016.05.005
Citation: Chang REN, Da-chun ZHAO, Lan ZHU. Prevention of Postoperative Adhesions with N, O-carboxymethyl Chitosan in Rabbit: A Large-sample Gross and Histopathological Observation[J]. Medical Journal of Peking Union Medical College Hospital, 2016, 7(5): 347-352. doi: 10.3969/j.issn.1674-9081.2016.05.005

羧甲基壳聚糖预防兔手术后粘连的效果:大体和病理学大样本观察

doi: 10.3969/j.issn.1674-9081.2016.05.005
详细信息
    通讯作者:

    朱兰 电话:010-69155649, E-mail:zhu_julie@vip.sina.com

  • 中图分类号: R713

Prevention of Postoperative Adhesions with N, O-carboxymethyl Chitosan in Rabbit: A Large-sample Gross and Histopathological Observation

More Information
  • 摘要:   目的  评价羧甲基壳聚糖(N, O-carboxymethyl chitosan, NOCC)预防兔手术后粘连的效果。  方法  220只雌性大耳白兔采用双子宫模型造成手术粘连, 随机分组后接受单纯造模手术(对照组)或造模手术+关腹前腹腔内注射NOCC(NOCC组)。所有手术均由同一位术者完成。每组各22只大耳白兔在实验设计的5个观察时间点(术后3、7、14、28和42 d)分别被处死并评估其粘连情况, 包括范围、类型和强度等大体情况和炎症、纤维化以及新生血管等镜下情况。  结果  NOCC组在术后3 d时其粘连的范围(P=0.0337)和强度(P=0.0271)以及炎症反应情况(P < 0.0001)均显著轻于对照组。在术后14 d内, NOCC组的纤维化情况均明显轻于对照组(P均 < 0.0005)。与对照组相比, NOCC组的粘连强度在术后14、28、42 d均明显减轻(P均 < 0.05), 而其粘连类型评分在术后28和42 d也明显降低(P均 < 0.05)。  结论  经NOCC处理后, 兔盆腹腔术后粘连大体和病理学评分均不同程度降低。应用NOCC可有效预防盆腹腔术后粘连。
  • 图  1  大耳白兔双子宫造模手术后盆腹腔粘连的大体观察

    因两组变化趋势相似,故A~D均展示对照组大体所见;A.术后3 d对照组:子宫和膀胱间的疏松、膜状粘连;B.术后7 d对照组:可见1例新生血管(箭头);C.术后28 d对照组:新生血管网形成(箭头);D.术后42 d对照组:粘连范围较28 d降低;E.术后42 d NOCC组:粘连更疏松,新生血管更细NOCC:羧甲基壳聚糖

    图  2  大耳白兔双子宫造模手术后盆腹腔粘连的病理表现(HE染色,×150)

    A.术后3 d对照组:可见微脓肿(箭头);B.术后7 d对照组:可见新生微毛细管(箭头);C.术后28 d对照组:可见一条有完整结构的大毛细血管,在其下方可见慢性炎症细胞浸润(箭头);D.术后42 d对照组:纤维密度增加; E.术后42 d NOCC组:新生血管与术后28 d相似NOCC:同图 1

    表  1  NOCC组和对照组在术后5个时间点的大体粘连评价情况

    术后时间(d) 粘连特征 对照组[M(Q1, Q3)] NOCC组[M(Q1, Q3)] P
    3 范围 2 (1,2) 1 (1,2) 0.0337
    类型 2 (2,2) 2 (2,2) 0.7638
    强度 2 (1.25,2) 1 (1,2) 0.0271
    7 范围 2 (1,2) 2 (1,2) 0.4257
    类型 2 (2,2) 2 (1.25,2) 0.4609
    强度 2 (1.25,2) 1 (1,2) 0.1026
    14 范围 2 (1,2) 1.5(1,2) 0.4693
    类型 2 (2,1) 2 (1,2) 0.1142
    强度 2 (1,2.75) 1 (1,2) 0.0410
    28 范围 2.5(1,2) 2 (1.25,2) 0.5006
    类型 2 (2,2) 2 (1,2) 0.0210
    强度 2 (2,2) 1 (1,1) <0.0001
    42 范围 2 (1,2) 1 (0,1) 0.1475
    类型 2 (1,2) 1 (0,1) 0.0027
    强度 2 (1,2) 1 (0,1) 0.0002
    NOCC:同图 1
    下载: 导出CSV

    表  2  NOCC组和对照组在术后5个时间点的镜下粘连评价情况

    术后时间(d) 镜下所见 对照组[M(Q1, Q3)] NOCC组[M(Q1, Q3)] P
    3 炎症反应 5 (4, 6) 3(1, 3.75) <0.0001
    纤维化 4 (3, 4) 3(2, 3) 0.0004
    血管增生 0 (0, 0) 0(0, 0) 1.0000
    7 炎症反应 2 (1, 3) 2(0, 4) 0.9044
    纤维化 3 (3, 3.75) 1(1, 2) <0.0001
    血管增生 2 (2, 4.75) 2(2, 3) 0.2717
    14 炎症反应 1 (0.25, 2) 1(0, 1) 0.8226
    纤维化 3 (3, 4) 2(0.25, 2.75) 0.0002
    血管增生 4 (1.25, 5) 2(1, 3.75) 0.1012
    28 炎症反应 0 (0, 1) 1(0, 2) 0.1468
    纤维化 3 (3, 3.75) 3(2, 3) 0.4036
    血管增生 2.5(2, 4) 3(2, 3) 0.8155
    42 炎症反应 0 (0, 1) 1(0, 1) 0.4109
    纤维化 3 (2.25, 4) 2(2, 3) 0.0501
    血管增生 4 (2, 4.75) 3(2, 3) 0.2626
    NOCC:同图 1
    下载: 导出CSV
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  • 收稿日期:  2016-07-05
  • 刊出日期:  2016-09-30

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