Background

In 80% to 90% of the patients intra-abdominal adhesions occur after abdominal surgery, which can cause small-bowel obstruction, chronic abdominal pain, female infertility and difficulty during reoperation. A novel crosslinked hyaluronic acid gel is evaluated regarding its anti-adhesive capacities in an ischemic button model in rats.

Method

51 adult, male Wistar rats from a registered breeder, received eight ischemic buttons each and were treated with hyaluronic acid gel (HA, HyaRegen^©), hyaluronic acid carboxymethylcellulose (HA-CMC, Seprafilm^©) or no anti-adhesive barrier. After 14 days, the animals were sacrificed and adhesions were scored macroscopically. The number of buttons and organs involved in adhesions were recorded. Per animal, one button with adhesions and one without adhesions was explanted for qPCR analysis. Mann-Whitney U, Fisher’s exact and Wilcoxon signed rank test were used for data analysis. A p-value of 0.05 was considered significant.

Results

Macroscopic evaluation of adhesion formation did not differ between the groups. The number of organs involved in adhesions in the HA gel group was significantly lower compared to HA-CMC (p = .041) and the control group (p = .012). A significantly, 1.36-fold higher clec10a (p = 0.25), 1.80-fold higher cd163 (p = 0.003) and 5.14-fold higher mmp1 expression (p = 0.028) was found in ischemic buttons with adhesions compared to buttons without adhesions.

Conclusion

HA gel application reduces the number of organs involved in adhesions in an ischemic button model, but no overall reduction in adhesion formation was encountered. Macrophage subtype 2 polarization and high mmp1 expression are associated with adhesion formation. Further investigation is needed in the exact pathophysiologic process of adhesion formation and the role of macrophage polarization.

中文翻译：

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通过透明质酸凝胶预防腹内粘连；在大鼠中进行的一项实验研究。

背景

80%～90%的患者腹腔粘连发生于腹部手术后，可引起小肠梗阻、慢性腹痛、女性不孕和再手术困难。评估了一种新型交联透明质酸凝胶在大鼠缺血性纽扣模型中的抗粘连能力。

方法

来自注册饲养员的 51 只成年雄性 Wistar 大鼠，每只接受 8 个缺血性纽扣，并用透明质酸凝胶（HA，HyaRegen ^©）、透明质酸羧甲基纤维素（HA-CMC，Seprafilm ^©）或无抗粘连屏障治疗。14天后，处死动物，肉眼观察粘连情况。记录涉及粘连的按钮和器官的数量。每只动物，一个有粘连的按钮和一个没有粘连的按钮被移植用于 qPCR 分析。Mann-Whitney U、Fisher精确和Wilcoxon符号秩检验用于数据分析。p 值为 0.05 被认为是显着的。

结果

粘连形成的宏观评价在各组之间没有差异。与 HA-CMC (p = .041) 和对照组 (p = .012) 相比，HA 凝胶组中涉及粘连的器官数量显着减少。与没有粘连的按钮相比，在有粘连的缺血按钮中发现了1.36 倍高的clec 10a (p = 0.25)、1.80 倍高的cd 163 (p = 0.003) 和高 5.14 倍的mmp1表达 (p = 0.028) .

结论

HA 凝胶应用减少了缺血按钮模型中涉及粘连的器官数量，但没有发现粘连形成的总体减少。巨噬细胞亚型 2 极化和mmp1高表达与粘连形成有关。粘连形成的确切病理生理过程和巨噬细胞极化的作用需要进一步研究。