摘要
目的对比研究创伤、缺血、感染及异物所致大鼠腹膜粘连的发生和发展特点。方法将236只SD大鼠随机分成5组。A组:假手术对照组;B组:滑石粉致粘连组;C组:创伤致粘连组;D组:感染致粘连组;E组:结扎血管致粘连组。各组分别用相应的方法处理蚓突盲端制造肠粘连模型,造模后1、2、4、8周以Bhatia分级法评定蚓突盲端的粘连程度,并对盲端组织行羟脯氨酸(OHP)水平测定和病理学检查。结果(1)腹膜粘连程度:1、2、4、8周B、C、D、E组粘连程度均显著重于A组(P<0·05),B组和D组又显著重于C组和E组(P<0·05);B、D组组内各时间点间粘连程度差异无统计学意义(P>0·05),C、E组内1、2、4周间差异无统计学意义(P>0·05),8周时粘连程度较前者显著减轻(P<0·05);(2)OHP水平:A组组内各时间点间差异无统计学意义(P>0·05);B、D、E组术后1、2、4周间OHP水平无显著性差异(P>0·05),8周时较前3个时间点显著下降(P<0·05);C组术后2周OHP水平(0·275±0·031)μg/mg显著高于1周[(0·221±0·036)μg/mg,P<0·05)],8周时OHP水平(0·254±0·030)μg/mg,显著低于1、2、4周(P<0·05);1、2、4周时B、C、D、E组OHP水平均明显高于A组(P<0·05),其中B组和D组的水平又明显高于C组和E组(P<0·05);8周时B组OHP水平(0·227±0·029)μg/mg仍显著高于A组[(0·151±0·026)μg/mg,P<0·05)],而C、D、E组已降至和A组差异无统计学意义(P>0·05);(3)粘连程度和OHP水平间的相关性:C、E组的粘连程度和OHP水平呈显著正相关(P<0·05),而B、D组的相关性则不明显(P>0·05);分别分析各时间点的五组所有样本,1、2、4周的粘连程度和OHP水平分别呈显著正相关(P<0·05),8周时则无显著相关性(P>0·05);(4)病理学检查:B组以异物肉芽肿反应及纤维组织增生为主,而其他各实验组以非特异性炎症反应及纤维组织增生为主。结论不同原因所致的腹膜粘连在发生和进展过程中各有特点,感染和异物所致的粘连相对于创伤和缺血所致的粘连,粘连程度重且可逆性差;以OHP水平衡量腹膜粘连程度时以粘连发生的早期较可靠。
Objective To investigate the characteristics of genesis and development of peritoneal adhesion by different causes. Methods 236 rats underwent laporotomy with their vermiform processes lifted up and were randomly divided into 5 groups ： Group A （ control group）, with the vermiform process exposed to air for 5 min, Group B, with the vermiform process smeared with talcum powder; Group C, with the vermiform process scraped by scalpel ; Group D, with the tip of vermiform process stabbed by needle so as to squeeze the contents of intestine to cause infection; and Group E, with the artery of vermiform process ligated. Then the abdominal incision was sutured. 1, 2, 4, and 6 weeks after the treatment 11 - 12 rata from each group were randomly to undergo laporotomy. The degree of adhesion was graded blindly by Bhatia＇ s method. The vermiform process was resected to undergo pathological examination and examination of the level of organ hydroxyproline （OHP） was detected. Results （ 1 ） At different time points the adhesive grades of Groups B - E were all significantly higher than that of Group A （ all P 〈 0.05） and the adhesive grades of Groups B and D were both significantly higher than those of Groups C and E （ both P 〈 0.05 ）. There were no significant differences in the adhesive degree 1, 2, and 4 weeks after the treatment between Groups C and E, however, the adhesive degree of Group E was significantly lower than that of Group C （P 〈0.05）. （2） There were not significant differences in the OHP levels at any time points in Group A （all P 〉 0.05 ）. There were not significant differences in the OHP levels 1, 2, and 4 weeks after the treatment （ all P 〉 0.05 ）, and the levels 8 weeks after the treatment were all significantly lower than those 1, 2, and 4 weeks after the treatment （ all P 〈 0.05 ） in Groups B, D, and E. In Group C the OHP level 2 weeks after the treatment was 0. 275 ±0. 031 μg/mg protein, significantly lower than that 1 week after （0. 221 ±0. 036 μg/mg protein, P 〈 0.05 ）, and the OHP level 8 weeks after the treatment was 0. 254 ± 0. 039μg/mg protein, significantly lower than those 1, 2, and 4 weeks after （ all P 〈 0.05 ）. The OH levels 1, 2, and 4 weeks after the treatment of the 4 experimental groups were all significantly higher than that of the control group （ all P 〈 0.05 ）. 8 weeks after the treatment the level of OHP of Groups B was significantly higher than that of Group A （P〈0.05）, however, the OHP levels of Group C, D, and E had all decreased to almost similar to that of Group A （ all P 〉 0.05 ） . （ 3 ） The adhesive degrees of Groups C and E were significantly positively correlated with the OHP level （ both P 〈0.05 ）, however, the adhesive degrees of Groups B and D were not significantly correlated with the OHP level （ both P 〉 0.05 ）. The adhesive degrees 1, 2, and 4 weeks after the treatment of the 5 groups were all significantly positively correlated with the OHP levels （ all P 〈 0.05, however, the adhesive degrees 8 weeks after the treatment of the 5 groups were all not significantly correlated with the OHP levels （all P 〉0.05）. （4） The main pathological changes of Group B were foreign body granuloma reaction and fibroplasias in Group B and unspecific inflammatory reaction and fibroplasias in Groups C, D, and E. Conclusion Abdominal adhesions resulting from different causes show different characteristics. The abdominal adhesion caused by foreign bodies and that caused by infection are relatively severe and more difficult to recover than those caused by injury and ischemia. It is more reliable to use OHP level as a marker of abdominal adhesion in the early stage.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2006年第46期3285-3289,共5页
National Medical Journal of China
基金
国家自然科学基金资助项目(50173023)
关键词
腹膜
粘连
大鼠
Peritoneum
Adhesion
Rat
