拉钩压迫损伤对腹膜纤溶及粘连形成影响的实验研究  

Study of operative pull0-hook constriction injure in peritonaeum fibrinolysis and adhesion form

作　　者：张翔[1] 秦建国[1] 庞家芳[1] 张连阳[2] 

机构地区：[1]解放军第44医院外二科,贵阳550009 [2]第三军医大学大坪医院普外科

出　　处：《贵州医药》2001年第10期880-883,共4页Guizhou Medical Journal

摘　　要：目的探讨拉钩压迫后腹膜粘连形成的纤溶机理及其防治。方法选用健康Wistar雄性大白鼠 48只 ,随机分为两组 ,即 1小时和第 5天两个时相点 ,观察粘连情况、腹膜病理改变 ,以Mas son组织化学染色观察胶原纤维 ,同时应用发色底物法测定腹膜组织型纤溶酶原激活物 (t PA)和纤溶酶原 (PLG)活性。结果拉钩压迫 1小时即可造成腹膜损伤 ,表现为HE染色见腹膜充血、水肿 ,同时腹膜t PA、PAI及PLG活性均明显下降 (P <0 0 1)。至损伤后第 5天 ,HE染色各组均可见腹膜层明显增厚 ,纤维组织增生等 ;Masson染色可见胶原层明显增厚 ,胶原纤维增生、排列紊乱 ;腹膜t PA及PLG活性均较损伤后 1小时升高 (P <0 0 5 ) ,但仍低于正常对照 (P <0 0 1) ,而PAI活性已恢复至正常水平(P >0 0 5 )。结论 (1) 2 0 0g拉力持续牵引拉钩压迫腹膜 1小时 ,可造成大鼠腹膜损伤 ,至第 5天时出现胶原纤维增生 ,腹膜粘连形成 ;(2 )拉钩损伤腹膜后第 5天 ,腹膜t PA和PLG活性下降 ,是导致腹膜胶原纤维增生、腹膜粘连的重要机理 ;(3)提高腹膜纤溶活性 ,在损伤后 5～ 7天内减少纤维蛋白渗出、沉积 ,清除FGM 。Objective To explore mechanism of peritonaeum adhesion form of operative pull hook constriction and prevention and cure.Methods 48 male wistar rats were divided into two groups. The peritonaeum adhesion and pathological changes were observed in 1hr and the 5th days same time after operative pull hook constriction. The collagenous fibers, t PA and PLG were measured by histochemistry and flash substrate methods. Results Operative pull hook constriction tissue rised peritonaeum injure, hyperemia, oedema and t PA , PAI and PLG active decresed ( P <0.01).The 5th days of operation that peritonaeum was raised thick , fibrase hyperplasia, t PA and PLG active increased than that the 1hr after operation ( P <0.05). Conclusion To increase fibrinolysis active and to decrease fibrin oozed, precipitate and clear FGM may be a good methods to prevention and cure adhesion of peritonaeum.

关 键 词：腹膜粘连 腹膜损伤 腹膜纤溶 拉钩压迫损伤 

分 类 号：R656.4[医药卫生—外科学]