羧甲基壳聚糖-羧甲基纤维素膜对结肠吻合口愈合的影响  

EFFECT OF CARBOXYMETHYLCHITOSAN-CARBOXYMETHYLCELLULOSE FILM ON COLONIC ANASTOMOSIS HEALING

作　　者：肖海军 侯春林[2] 薛锋 

机构地区：[1]上海奉贤区中心医院骨科,上海201400 [2]第二军医大学附属长征医院骨科

出　　处：《中国修复重建外科杂志》2009年第4期451-455,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(30170956)~~

摘　　要：目的评估羧甲基壳聚糖(carboxymethylchitosan,CMCH)-羧甲基纤维素(carboxymethylcellulose,CMC)膜预防结肠吻合口粘连的效果及其对吻合口愈合能力的影响。方法取64只成年健康雄性SD大鼠随机分为对照组和实验组(n=32),按Buckenmaier等的方法制备鼠结肠吻合口动物模型。对照组吻合口不作任何处理;实验组用3cm×2cm的CMCH-CMC膜包裹结肠吻合口部位。于术后7d和14d观察吻合口粘连情况;测定吻合口抗张强度,并与6只正常大鼠结肠抗张强度进行比较;检测吻合口羟脯氨酸(hydroxyproline,HP)含量。结果术中及术后共死亡5只大鼠,实验组2只,对照组3只。术后7、14d粘连评分对照组分别为(1.67±0.15)、(2.29±0.18)分(P<0.05),实验组分别为(0.50±0.16)、(0.45±0.14)分(P>0.05);两组比较差异均有统计学意义(P<0.01)。术后7、14d吻合口抗张强度对照组分别为(138.67±16.65)、(178.36±20.10)mmHg(1mmHg=0.133kPa,P<0.01);实验组分别为(130.81±18.38)、(172.74±22.18)mmHg(P<0.01);两组比较差异无统计学意义(P>0.05)。术后7d两组吻合口抗张强度与正常大鼠比较差异有统计学意义(P<0.01)。术后7、14d吻合口HP含量对照组分别为(55.47±12.89)、(137.14±16.81)μg/mg干重组织(P<0.01);实验组分别为(84.47±11.87)、(146.07±14.81)μg/mg干重组织(P<0.01);术后7d两组差异有统计学意义(P<0.05),术后14d差异无统计学意义(P>0.05)。结论CMCH-CMC膜在预防结肠吻合口周围粘连形成的同时不干扰吻合口的愈合。Objective To investigate the effects of carboxymethylchitosan- carboxymethylcellulose （CMCH-CMC） film on the adhesion and heal ing of colonic anastomosis. Methods Sixty-four healthy adult male SD rats was randomly divided into control group and experimental group （n=32）. The model of colonic anastomosis was made according to Buckenmaier＇ s method in all rats. The experimental group was treated by wrapping anastomosis with CMCH-CMC film （3 cm × 2 cm） and the control group was not treated. At 7 days and 14 days after operation, the adhesion formation of colonic anastomosis was observed, the tensile strength of the anstomosis was assessed and compared with 6 normal rats, and the hydroxyprol ine （HP） content of the anastomotsis was detected. Results There were 3 deaths in the experimental group and 2 deaths in the control group. The adhesive scores of the experimental group on the 7th and 14th postoperative day [（0.50 ± 0.16） points and （0.45 ± 0.14） points, （P〈 0.05）] were significantly lower than those of the control group [（1.67 ± 0.15） points and （2.29 ± 0.18） points, （P 〈 0.05）], （P〈 0.01）. Tensile strength were more marked on the 14th postoperative day than on the 7th postoperative day in the control group （P〈 0.05）, but there was no significant difference between the 7th day and the 14th day in the experimental group. The tensile strength of the control group and the experimental group on the 14th postoperative day [（178.36 ± 20.10） and （172.74 ± 22.18） mmHg] were respectively higher than those on the 7th postoperative day [（138.67 ± 16.65） and （130.81 ± 18.38） mmHg] （P〈 0.01）. The tensile strength of the control group and the experimental group on the 7th postoperative day were respectively significantly lower than that of the normal rats （P 〈 0.01）. The level of HP in the anastomosis was significantly higher on the 7th postoperative day in the experimental group [（84.47 ± 11.87） μg/mg dried weight] than that

关 键 词：羧甲基壳屎糖-羧甲基纤维素膜 结肠吻合口 愈合 粘连 大鼠 

分 类 号：R656.9[医药卫生—外科学]