Membrane Journal (멤브레인)

The Membrane Society of Korea (한국막학회)
권호 표지

Evaluation on Effectiveness for Preventing Post Surgical Adhesion of Sodium Hyaluronate/Sodium Carboxymethyl Cellulose (HA/CMC) Membrane in Rat Cecum/Peritonium Model

쥐 맹장/복벽 찰과상 모델에서 Sodium Hyaluronate/sodium Carboxymethyl Cellulose 멤브레인의 수술 후 유착방지에 대한 유효성 평가

  • Lee, Young-Moo (School of Chemical Engineering, College of Engineering , Hanyang University) ;
  • Lee, Young-Woo (School of Chemical Engineering, College of Engineering , Hanyang University)
  • 이영무 (한양대학교 응용화학공학부) ;
  • 이영우 (한양대학교 응용화학공학부)
  • Published : 2005.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

We prepared an anti-adhesion membrane made of sodium hyaluronate/sodium carboxymethylcellulose (HA/CMC) and evaluated its effectiveness for adhesion prevention in a rat model. The anti-adhesion membrane was prepared by lyophilizing HA/CMC solution and cross-linking properly with 1-Ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDAC). In a cecum/abdominal wall abrasion model of Sprague-Dawley rat, cecal serosa and abdominal wall were abraded in $1\times2\;(cm^2)$ with a bone burr after peritoneal midline incision and sutured at 3 points around the injured surface. The denuded cecum was covered with HA/CMC membrane (experimental group), or nothing (control group) and apposed to the abdominal wall. Most of the control group represented 3 or more of adhesion grade at POD 7, 14, 21, and 28, whereas $60\~70\%$ of the experimental group was 2 or less of adhesion grade at 14, 21, and 28. It was similar in the adhesion strength. In a general manner, the adhesion grade and strength showed gradual increasing until POD 14, almost same or a little increasing POD 21, but decreasing POD 28. Also the control group was much higher in adhesion grade, strength, and area than the experimental group. It is expected that the anti-adhesion membrane will have a good clinical result in postoperative adhesion prevention.

본 연구에서는 히알루론산나트륨/카르복시메틸셀룰로오스나트륨(HA/CMC)으로 구성된 유착방지 막을 제조하였고, 쥐에서 유착방지용에 대한 효과를 평가하였다. 유착방지 막은 HA/CMC 용액을 동결건조한 후 1-에틸-3-(3-디메틸아미노프로필)카보디이미드 (EDAC)로 가교하여 제조하였다. Sprague-Dawley쥐의 맹장/복벽 찰과상 모델에서 복부 중앙선 절개 후 장막과 복벽을 bone burr로 $1\times2\;(cm^2)$ 크기로 찰과상을 만들고, 상처 면 주위의 3곳을 봉합사로 고정시켰다. 상처난 장을 실험군의 경우 HA/CMC 막으로 덮어주었으며, 대조군은 아무처치도 하지 않은 상태로 복벽을 마주보게 하였다. 대조군의 대부분은 수술 후 7, 14, 21, 28일에 유착정도 3 이상을 나타내었고, 반면 실험군의 $60\~70\%$는 수술 후 14, 21, 28일에 유착정도 2 이하를 나타내었다. 이는 유착세기에서도 유사하였다. 일반적으로 유착정도와 유착세기는 수술 후 14일까지 점차 증가하였고, 수술 후 21일에는 거의 동일하거나 약간 증가하였으며, 28일째에는 감소하였다. 대조군은 유착정도와 유착세기, 유착면적에서 높은 수치를 나타내었다. 이 유착방지막은 수술 후 유착방지에서 좋은 임상결과를 나타낼 수 있을 것으로 기대된다.

Keywords

References

  1. N. F. Ray, W. G. Denton, M. Thamer, S. C. Henderson, and S. Perry, 'Abdominal adhesiolysis: inpatient care and expenditures in the U.S. in 1994', J. Am. Coll. Surg., 186(1), 1 (1998)
  2. H. van Goor, 'Morbidity and mortality of inadvertent enterotomy during an adhesiotomy', British Journal of Surgery, 87, 467 (2000)
  3. H. J. Chung, M. J. Cosenza, R. Rahbar, and R. B. Metson, 'Mitomycin C for the prevention of adhesion formation after endoscopic sinus surgery: A randomized, controlled study', Otolaryngol. Head Neck Surg., 126, 468 (2002) https://doi.org/10.1067/mhn.2002.124705
  4. H. H. Ramadan, 'Surgical causes of failure in endoscopic sinus surgery', Laryngoscope, 109, 27 (1999)
  5. J. R. von Kurman and T. M. Mazur, 'Benign disease of the endometrium', Blaustein's pathology of the female genital tract, pp. 315-316, Springer, Berlin (1987)
  6. N. F. Ray, J. W. Jr. Larsen, R. J. Stillman, and R. J. Jacobs, 'Economic impact of hospitalizations for lower abdominal adhesiolysis in the United States in 1988', Surg. Gynecol. Obstet., 176, 271 (1993)
  7. K. Falk, P. Bjorquist, M. Stromqvist, and L. Holmdahl, 'Reduction of experimental adhesion formation by inhibition of plasminogen activator inhibitor type 1', British Journal of Surgery, 88, 286 (2001) https://doi.org/10.1046/j.1365-2168.2001.01651.x
  8. J. W. Burns, M. J. Colt, L. S. Burgess, and K. C. Skinner, 'Preclinical Evaluation of $Seprafilm^{TM}$ Bioresorbable Membrane', Eur. J Surg. Suppl., 577, 40 (1997)
  9. T. E. Elkins, F. W. Ling, and R. A. Ahokas, 'Adhesion prevention by solutions of sodium carboxymethylcellulose in the rat Parts I & II', Fertil. Steril., 41, 926 (1984)
  10. C. M. Fredericks, L. Kotry, G. Holtz, A. H. Askalani, and G. I. Serour, 'Adhesion prevention in the rabbit with sodium carboxymethylcellulose solutions', Am. J. Obstet. Gynecol., 155, 667 (1986)
  11. M. P. Diamond, 'Reduction of de novo postsurgical adhesions by intraoperative precoating with Sepracoat (HAL-C) solution: a prospective, randomized, blinded, placebo-controlled multicenter study. The Sepracoat Adhesion Study Group.', Fertil. Steril., 69(6), 1067 (1998)
  12. S. H. Shim, Y. W. Lee, Y. M. Lee, Y. H. Oh, S. W. Kwon, J. H. Kim, and S. K. Sohn, 'Evaluation of resorbable materials for preventing surgical adhesion on rat experiment', J. Kor. Surg. Soc., 63(3), 179 (2002)
  13. A. Vlahos, P. Yu, C. E. Lucas, and A. M. Ledgerwood, 'Effect of a composite membrane of chitosan and Poloxamer gel on postoperative adhesive interactions', The American Surgeon, 67, 15 (2001)
  14. D. A. Grainger, 'Incidence and causes of pelvic adhesions', Infert. Reprod. Med. Clin. North Am., 5(3), 391 (1994)
  15. K. E. Rodgers, 'Late peritoneal response to infection and injury: Adhesion formation', Sepsis, 3, 317 (1999)
  16. E. S. Harris, R. F. Morgan, and G. T. Rodeheaver, 'Analysis of the kinetics of peritoneal adhesion formation in the rat and evaluation of potential antiadhesive agents', Surgery, 117, 663 (1995)
  17. R. P. S. Jansen, 'Failure of peritoneal irrigation with heparin during pelvic operations upon young women to reduce adhesion', Surg. Gynecol. Obstet., 166, 154 (1988)
  18. Adhesion Study Group, 'Reduction of postoperative pelvic adhesions with intraperitoneal 32% dextran 70: A prospective, randomized clinical trial', Fertil. Steril., 40, 612 (1983)
  19. J. R. Pappenheimer, 'Passage of molecules through capillary walls', Physiol. Rev., 33, 387 (1953)
  20. J. Rozga, B. Ahren, and S. Bengmark, 'Prevention of adhesions by high molecular weight dextran in rats; Re-evaluation in nine experiments', Acta Chir. Scand., 156, 763 (1990)
  21. W. A. Polishuk and B. Bercovici, 'Intraperitoneal low molecular weight dextran in tubal surgery', J. Obstet. Gynaecol. Br. Commonw., 78, 724 (1971) https://doi.org/10.1111/j.1471-0528.1971.tb00213.x
  22. H. D. Moll, J. Schumacher, and J. C. Wright, 'Evaluation of sodium carboxymethylcellulose for prevention of adhesions after uterine trauma in ewes', Am. J. Vet. Res., 53, 1454 (1992)
  23. B. Urman, V. Gomel, and N. Jetha, 'Effect of hyaluronic acid on postoperative intraperitoneal adhesion formation in the rat model', Fertil. Steril., 56, 563 (1991)
  24. G. Oelsner, R. A. Graebe, S. B. Pan, F. P. Haseltine, E. R. Barnea, H. Fakih, and A. H. DeCherney, 'Chondroitin sulphate: A new intraperitoneal treatment for postoperative adhesion prevention in the rabbit', J. Reprod. Med., 32, 812 (1987)
  25. I. R. King, 'Candida albicans pelvic abscess associated with the use of 32% dextran-70 in conservative pelvic surgery', Fertil. Steril., 51, 1050 (1989)
  26. J. M. Becker, M. T. Dayton, V. W. Fazio, D. E. Beck, S. J. Stryker, S. D. Wexner, B. G. Wolff, P. L. Roberts, L. E. Smith, S. A. Sweeney, and M. Moore, 'Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, doubleblind multicenter study', J. Am. Coll. Surg., 183, 297 (1996)
  27. P. A. D. Iaco, M. Stefanetti, D. Pressato, S. Piana, M. Don, A. Pavesio, and L. Bovicelli, 'A novel hyaluronan-based gel in laparoscopic adhesion prevention: preclinical evaluation in an animal model', Fertil. Steril., 69(2), 318 (1998)
  28. A. M. Ghellai, A. F. Stucchi, D. F. Lynch, K. C. Skinner, M. F. Colt, and J. M. Becker, 'Role of a hyaluronate-based membrane in the prevention of peritonitis-induced adhesions', J. Gastrointest. Surg., 4, 310 (2000)
  29. K. E. Greenawalt, T. J. Butler, E. A. Rowe, A. C. Finneral, D. S. Garlick, and J. W. Bums, 'Evaluation of sepramesh biosurgical composite in a rabbit hernia repair model', J. Surg. Res., 94, 92 (2000)