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Clinical Analysis of 27 Cases of Laparoscopic Enterodialysis to Treat Adhesive Ileus

目的　探讨腹腔镜粘连松解术治疗粘连性肠梗阻的应用价值。方法　对我院2005年7月至2011年9月期间采用腹腔镜进行肠粘连松解术的27例患者的临床资料进行回顾性分析。结果　27例患者中除2例因术中探查发现小肠坏死而中转开腹行肠切除外，其余25例均手术成功，手术时间（65±15） min （40～115min）。27例均获随访，随访时间（14±6）个月（8个月～2年），1例患者于术后1个月时有阵发性腹痛，经保守治疗缓解，其余病例均无腹胀、腹痛等症状发生。结论　腹腔镜粘连松解术治疗粘连性肠梗阻具有创伤小、恢复快的优点，是较理想的治疗术后肠粘连的手段。

Application of Ultrasonically Activated Scalpel in Laparoscopic Intestinal Adhesion Release

【Abstract】ObjectiveTo study the application of ultrasonically activated scalpel in laparoscopic intestinal adhesion release.MethodsIntestinal adhesion release with ultrasonically activated scalpel under laparoscope was performed in 29 patients suffered from intestinal adhesive obstruction after gynecological operation. ResultsAll operations were successfully performed, and none of them converted into open surgery. Intestinal disruption occurred durring operation in 2 patients with extensive intestinal denseadhesion which were mended successfully under laparoscope. The operative duration was 30-150 min (mean 45 min). Postoperative complications such as bowel leakage, bleeding, abdominal infection were not experienced. Postoperative hospital stay was 3-7 days (mean 4 days). No case had relapse symptom such as abdominal distention or pain after 1-24 months of followup. ConclusionCompared with electric scalpel, ultrasonically activated scalpel can improve the operative safety, lessen tissue damage, shorten operative time, and reduce the chance of relapse in laparoscopic operation in gynecology.

Inhibition effect of salazosulfapyridine on the formation of postoperative abdominal adhesion in rat models

Objective To investigate the inhibition effect of salazosulfapyridine (SF) on the formation of post-operative abdominal adhesion and its possible mechanism. Methods Forty male Sprague-Dawley rats were randomly divided into five groups: sham operation group (Sham group), blank control group (BC group), sodium hyaluronate (HA) group, low dose of SF group (LSF group), and high dose of SF group (HSF group). Except the Sham group, all the rats in other 4 groups were created abdominal adhesion model by abrasion of caecum and its opposite abdominal wall. Rats of the BC group didn’t received any treatment after model establishment. Before closing the abdominal wall, the rats of the HA group were treated by 2 mL HA. After the operation, the rats of the LSF group and the HSF group were daily orally administrated with different dose of SF (50 mg/kg for the LSF group and 100 mg/kg for the HSF group), while the other 3 groups treated with same dose of normal saline. Seven days after operation, the rats of 5 groups were killed and abdominal adhesion conditions was evaluated by Nair’s score system. Then the abdominal adhesion tissues or blood were collected to underwent HE staining, immunohistochemistry staining, and enzyme linked immunosorbent assay (ELISA) test. The HE staining was used to assess the inflammation score and fibrillation score of rats in 5 groups and immunohistochemistry staining was used to evaluate expression of the α-smooth muscle actin(α-SMA) in adhesion tissues. The ELISA test was used to detect the concentration of serum interleukin-1β (IL-1β) and transforming growth factor-β1 (TGF-β1) in rats of 5 groups. Results ① The gross evaluation of adhesion condition:3 rats of the Sham groups had incision adhesion; in the BC group, 4 rats had incision adhesion, 8 rats had cecum to the abdominal wall adhesion, 2 rats had viscera to viscera adhesion; in the HA group, 2 rats had incision adhesion and5 rats had cecum to the abdominal wall adhesion; in the LSF group, 2 rats had incision adhesion, 6 rats had cecum to the abdominal wall adhesion, and 1 rat had viscera to viscera adhesion; in the HSF group, 2 rats had incision adhesion and 4 rats had cecum to the abdominal wall adhesion. Compared with the Sham group, the Nair’s scores of the other4 groups were higher (P<0.05); compared with the BC group, the Nair’s scores of the HA group, the LSF group, and the HSF group were all lower (P<0.05), but there was no significant difference on the Nair’s scores among the HA group, the LSF group, and the HSF group (P>0.05). ② Inflammation score and fibrillation score: on the inflammation score, compared with the Sham group, the inflammation scores of the others 4 groups were higher (P<0.05); compared with the BC and HA group, the inflammation scores of the LSF group and the HSF group were both lower (P<0.05); compared with the LSF group, there was no significant difference on the inflammation score of the HSF group (P>0.05). On the fibrillation score, compared with the Sham group, the fibrillation scores of the others 4 groups were higher (P<0.05); compared with the BC group, the fibrillation scores of the HA group, the LSF group, and the HSF group were all lower (P<0.05), but there was no significant difference on the fibrillation scores among the HA group, the LSF group, and the HSF group (P>0.05). ③ The expression scores of α-SMA: compared with the Sham group, the expression scores of α-SMA in the others 4 groups were higher (P<0.05); compared with the BC group, the expression scores of α-SMA in the HA group, the LSF group, and the HSF group were all lower (P<0.05), but there was no significant difference on the expression scores of α-SMA among the HA group, the LSF group, and the HSF group (P>0.05). ④ Concentration of serum IL-1β and TGF-β1: on the concentration of serum IL-1β, compared with the Sham group, the concentrations of serum IL-1β in the others 4 groups were higher (P<0.05); compared with the BC group, the concentrations of serum IL-1β in the HA group, the LSF group, and the HSF group were all lower (P<0.05); compared with the HA and the LSF group, the concentration of serum IL-1β in the HSF group was lower (P<0.05). On the concentration of serum TGF-β1, compared with the Sham group, the concentrations of serum TGF-β1 in the others 4 groups were higher (P<0.05); compared with the BC group, the concentrations of serum TGF-β1 in the HA group, the LSF group, and the HSF group were all lower (P<0.05); compared with the HA group, the concentrations of serum TGF-β1 in the LSF group and the HSF group were both lower (P<0.05), but there was no significant difference between the LSF group and the HSF group (P>0.05). Conclusion SF can reduce the formation of postoperative abdominal adhesion in rat models via inhibiting inflammation and fibrillation.

皮尔复液预防肠粘连的动物实验研究

链激酶预防肠粘连的动物实验研究

肠粘连是腹部手术常见的并发症之一，也是引起肠梗阻最常见的原因之一。据统计，腹部手术后腹腔粘连的发生率高达90%［1］，在引起肠梗阻的因素中约40%是由于术后肠粘连引起，因此探索能有效预防术后肠粘连的新方法具有十分重要的临床意义。链激酶是一种临床广泛应用于溶栓的高效酶，它具有促进纤维蛋白溶解系统活性的作用，能促使纤维蛋白溶酶原激活因子前体，转变为有活性的纤维蛋白溶酶，从而发挥溶解血栓的作用。本实验以SD大鼠为对象，初步研究了链激酶预防腹腔粘连的作用，现报道如下。

PLICATION OF SMALL INTESTINE FOR RECURRENT SMALL BOWEL OBSTRUCTION DUE TO ADHESIONS

Objective To array the small intestine so that the uncontrollable adhesions will turn to controllable abhesions in order to prevent the intestinal obstruction. Methods Literatures were reviewed. The advance of plication of small intestine has passed through three stages: 1st, sewing the intestine just like the array of harpsichord keys; then, using straight needle with coarse threads to make a ‘U’ suture for the mesentery of small intestine so the intestine was arrayed, and 3rd inserting a Millers-Abbott tube into the lumen of small intestine followed by manual arrangement of the intestine. Results Using the Millers-Abbott tube the intestine was fixed in a steady position and arrayed in a half moon circular shape to avoid sharp angle. As a result, the intra-luminal pressure of the intestinal was effectively decreased. Follow up 45 cases showed the cure rate of 91.9%. Conclusion This operation has widely been accepted by the surgeons for its simplicity, high efficacy and reliability. It reduces the recurrence rate of adhesive obstruction.

人体脂肪及α-糜蛋白酶联合腹腔灌注预防肠粘连的实验研究

几丁糖预防腹部术后肠粘连的疗效观察

目的 观察几丁糖预防腹部术后肠粘连的效果。 方法 2000 年1 月－ 2008 年12 月，收治再次剖腹手术患者127 例，其中69 例前次术中应用几丁糖（应用组），男41 例，女28 例，年龄13 ～ 82 岁。前次手术原因：胃肠、胆道及胰腺部癌30 例，弥漫性腹膜炎21 例，外伤性血腹8 例，粘连性肠梗阻及腹茧症6 例，大肠破裂4 例。58 例前次术中未应用几丁糖（对照组），男34 例，女24 例，年龄15 ～ 84 岁。前次手术原因：胃肠、胆道及胰腺部癌24 例，弥漫性腹膜炎18 例，外伤性血腹7 例，粘连性肠梗阻及腹茧症6 例，大肠破裂3 例。两组患者再次手术距前次手术时间为3 个月～ 9年。 结果 根据Phillips 和仲剑平分级标准评定粘连程度：应用组获0 级61 例，Ⅰ级6 例，Ⅱ级2 例；对照组获Ⅰ级5 例，Ⅱ级27 例，Ⅲ级16 例，Ⅳ级10 例；两组比较差异有统计学意义（P lt; 0.01）。 结论 几丁糖是一种预防术后肠粘连的较理想生物材料。

Experimental study of interferon-γ in preventing intestinal adhesion following abdominal surgery in rats

ObjectiveTo observe effect of interferon-γ in preventing intestinal adhesion following abdominal surgery in rats.MethodsA total of 60 Wistar rats were selected, which were randomly divided into a sham operation (SO) group, model group, dexamethasone (DXMS) group, and interferon-γ group, then the interferon-γ group was randomly divided into a low, medium, and high concentrations subgroups. Except for the SO group, the laparotomies with file friction caecum were performed for all the other groups to establish the intestinal adhesion model. SO group and model group were intraperitoneally injected with saline for 4 mL/kg. The 10 mg/kg dexamethasone was injected into the abdominal cavity of rats in the DXMS group. The 7.5×104, 1.5×105, and 3.0×105 U/kg interferon-γ concentrations were injected into the abdominal cavity of rats in the low, medium, and high concentrations subgroups respectively. The Nair grading of cecum adhesion degree was assessed on the 8th day after the surgery, then the histopathological change was observed by the HE staining under the microscopy and the hydroxyproline content in the cecum tissue was detected.Results① The intestinal adhesion: Compared with the SO group, the intestinal adhesions occurred in all the other groups and the degrees of intestinal adhesions evaluated by the Nair grading were more significantly serious (P<0.05), which in the DXMS group and the medium and high concentrations of interferon-γ subgroups were significantly reduced (P<0.05) as compared with the model group, which in the high concentration of interferon-γ subgroup was significantly reduced (P<0.05) as compared with the DXMS group. ② The microscopic observation of histopathological results: Compared with the DXMS group, the high concentration of interferon-γ could effectively reduce the occurrence of fibrous tissue and inflammatory cell infiltration, the intestinal wall muscular layer structure was complete, a few inflammatory cells scattered in the infiltration. ③ The hydroxyproline content: The contents of hydroxyproline in the cecum tissue of the model group, DXMS group, and interferon-γ subgroups were significantly increased (P<0.05) as compared with the SO group, which of the DXMS group and medium and high concentrations of interferon-γ subgroups were significantly decreased (P<0.05) as compared with the model group, which of the high concentration of interferon-γ subgroup was significantly decreased (P<0.05) as compared with the DXMS group.ConclusionInterferon-γ has a preventive and therapeutic effect on postoperative intestinal adhesion and cecum injuries.

Clinical Application of Artificial Pneumoperitoneum and Gastrointestinal Contrast CT Imaging in Diagnosis of Abdominal Wall Adhesion to Intestine after Operation

ObjectiveTo explore the feasibility and safety of the artificial pneumoperitoneum and gastrointestinal contrast CT imaging, and imaging diagnostic value on abdominal wall adhesion to intestine after operation. MethodsThirtynine patients with adhesive intestinal obstruction after operation relieved by conservative therapy were included from January 2008 to November 2009. After the artificial pneumoperitoneum established by injection of gas into abdominal cavity and gastrointestinal comparison by oral administration low concentration of meglucamine diatrizoate, CT scan imaging was performed and the radiographic results were compared with surgical findings. ResultsFour patients refused surgery and discharged, so enterolysis was performed in the remaining patients. The surgical findings were consistent with radiographic results. It was showed by laparoscopic operation that intestinal obstruction caused by the fibrous adhesions and the intestine did not adhere to the abdominal wall in eight patients with fibrous adhesion diagnosed by CT. Of eighteen patients with the abdominal wall septally adhered to the intestinal, the surgical findings showed the intestine and the abdominal wall formed “M”type adhesions and omentum adhesions in sixteen patients underwent open operation, and clear fat space was showed in eight patients and close adhesion was found in another eight patients between the intestine and abdominal wall. Of thirteen patients with the abdominal wall tentiformly adhered to the intestinal, the surgical findings showed the intestine and the abdominal wall formed continuous and tentiform adhesions and omentum adhesions to the intestine in eleven patients. After the followup of 6-18 months (mean 9 months), incomplete intestinal obstruction occurred in one patient and was relieved by conservative treatment. One patient with discontinuous discomfort in abdomen after operation did not receive any treatment. The other patients were cured. ConclusionThe artificial pneumoperitoneum and gastrointestinal contrast CT imaging can accurately show the location, area, and structure composition of the postoperative abdominal wall adhesion to intestine, which is safety, simple, and bly repeatable, and a better imaging method for the diagnosing of abdominal wall adhesion to intestine after operation.