医用防粘连改性壳聚糖膜对腹部手术后腹腔粘连的预防作用  

Preventive effects of modified chitosan medical anti-adhesion membrane on postoperative intraabdominal adhesion

作　　者：刘健[1] 周晓磊[1] 张鹏[1] 赵战朝[1] 

机构地区：[1]天津医科大学总医院外科,300052

出　　处：《中华医学杂志》2012年第44期3140-3142,共3页National Medical Journal of China

摘　　要：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。] 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% ） vs 4 （ 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 anti-adhesion membrane has preventive effects on postoperative intra-abdominal adhesion so as to decrease the incidence of adhesive ileus.

关 键 词：外科手术 手术后并发症 医用防粘连改性壳聚糖膜 

分 类 号：R656[医药卫生—外科学]