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Objective:To observe the clinical effects of intraperitoneal perfusion of bevacizumab combined with albumin paclitaxel and carboplatin in the treatment of malignant peritoneal adhesion caused by ovarian cancer.Methods:From January 2016 to December 2020, 54 patients treated in our hospital with malignant peritoneal adhesions caused by ovarian cancer were enrolled in this study. They were randomly divided into experimental group ( n=27) and control group ( n=27) according to the random number table method. The treatment regimen of the experimental group was intravenous infusion of albumin paclitaxel plus intraperitoneal infusion of carboplatin and bevacizumab. The treatment regimen of the control group was intra-venous infusion of albumin paclitaxel plus intraperitoneal infusion of carboplatin. The treatment was repeated every 21 days, and the therapeutic effect was evaluated every two cycles. The treatment lasted for six cycles. The efficacy and incidence of adverse reactions were compared between the two groups. Results:The remission rate of incomplete malignant bowel obstruction of the experimental group was higher than that of the control group [85.19% (23/27) vs. 59.26% (16/27)], the total effective rate of the experimental group was higher than that of the control group [74.07% (20/27) vs. 44.44% (12/27)], and there were statistically significant differences ( χ2=4.523, P=0.033; χ2=4.909, P=0.027). After treatment, the levels of vascular endothelial growth factor (VEGF) in ascites of the experimental group and the control group were significantly lower than those before treatment [(80.33±1.41) pg/ml vs. (310.45±3.35) pg/ml, t=449.884, P<0.001; (135.68±1.60) pg/ml vs. (310.46±3.09) pg/ml, t=499.281, P<0.001], and after treatment, the VEGF level in the experimental group decreased more significantly than that in the control group ( t=-134.907, P<0.001). Patients in the experimental group and the control group tolerated the treatment well, and there were no significant differences in the incidences of adverse reactions such as hypertension (11.11% vs. 3.70%, χ2=0.270, P=0.603), neutropenia (14.81% vs. 11.11%, χ2<0.001, P>0.999), peripheral neuropathy (3.70% vs. 0, χ2<0.001, P>0.999), diarrhea (7.41% vs. 3.70%, χ2<0.001, P>0.999), nausea (3.70% vs. 0, χ2<0.001, P>0.999), epistaxis (7.41% vs. 0, χ2=0.519, P=0.471) or albuminuria (3.70% vs. 0, χ2<0.001, P>0.999) between the two groups. Conclusion:Intraperitoneal perfusion of bevacizumab combined with chemotherapy is superior to simple chemotherapy in the treatment of malignant peritoneal adhesion caused by ovarian cancer.
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Peritoneal adhesion (PA) is a high morbidity complication after surgical procedures, with serious clinical consequences and requiring substantial medical expenditure. The pathogenesis of PA is complex and is still not very clear. Clinically, it is mainly treated by optimizing surgical protocols, using anti-adhesion drugs and biomaterial barriers. Although these methods have shown certain preventive effects, the effectiveness needs to be further improved. Elucidating the mechanism of PA formation is the basis and premise for preventing its occurrence. In the process of PA formation, a variety of inflammatory cells, inflammatory factors play important roles. In this paper, the mechanism of inflammation and immunoregulatory responses in the formation of adhesions in the peritoneal cavity was reviewed, in order to provide a reference for the improvement of PA prevention strategies.
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ABSTRACT:Objective To assess the effect of prolonged laparoscopic surgery on peritoneal mesothelial cells and fibrinolysis in humans.Methods We examined prospectively 1 6 consecutive patients who underwent laparoscopic surgery (LAP)and 2 1 patients who underwent conventional open surgery (OP)for high-medium rectal cancer with curative intent.During the procedure,biopsy of the parietal peritoneum was made before operation and at 45 min,90 min,and 120 min after operation.The tissue-type plasminogen activator (tPA)and plasminogen activator inhibitor-1 (PAI-1 )were determined by enzyme-linked immunosorbent assay in peritoneal tissues.The cellular injury was detected by LDH assay.The proliferation was quantified by MTT assay.Results PAI-1 activity in the peritoneal tissue was significantly lower in LAP group than in the OP group.tPA activity decreased after 45min of open surgery,but there was no significant change in the LAP group.With time extension,the LDH activity increased and the proliferation of the mesothelial cells decreased.Conclusion Preservation of a prolonged hypofibrinolytic state by inhibition of PAI-1 up-regulation during LAP may predispose patients to less postoperative peritoneal adhesion. The cellular injury becomes apparent and the proliferation is inhibited during prolonged laparoscopic surgery.
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Anti-adhesive materials were the hot spot in recent clinical study because opinions were vary from different experts . This paper aims to introduce the classification of anti-adhesive materials according to the different properties and expound the mecha-nism and application limitation of anti-adhesive .The pitfalls in current barrier materials research and future research directions are summarized and analyzed .
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OBJECTIVE: Postsurgical abdominal adhesions are common, serious postoperative complications. The present study compared the usefulness of 4% icodextrin and canola oil in preventing postoperative peritoneal adhesions. METHODS: Twenty-four Wistar albino rats were divided into three groups. Following a laparotomy, a serosal abrasion was made by brushing the cecum, and 3 mL of 0.9% NaCl, 4% icodextrin, or 3 mL of canola oil were intraperitoneally administered for the control, icodextrin, and canola oil groups, respectively. The abdomen was then closed. All of the rats were sacrificed at day 10. Macroscopic, histopathological, and biochemical evaluations were performed. The results were statistically analyzed using Kruskal-Wallis and ANOVA tests. RESULTS: Macroscopic analyses revealed that both canola oil and 4% icodextrin reduced adhesion formation, but the difference was not statistically significant (p = 0.17). The histopathological examinations revealed no significant differences in terms of giant cell, lymphocyte/plasmocyte, neutrophil, ICAM1, or PECAM1 scores. However, both canola oil and 4% icodextrin significantly reduced fibrosis (p = 0.025). In the canola oil group, the histiocytic reactions were significantly increased (p = 0.001), and the hydroxyproline levels were significantly lower than those in the other groups (p = 0.034). CONCLUSIONS: In the present study, canola oil was determined to be superior to 4% icodextrin in lowering hydroxyproline levels and increasing histiocytic reactions. Considering these results, we believe that canola oil is a promising agent for preventing adhesion formation.
Subject(s)
Animals , Female , Rats , Fatty Acids, Monounsaturated/therapeutic use , Glucans/therapeutic use , Glucose/therapeutic use , Peritoneal Diseases/prevention & control , Peritoneum/surgery , Rats, Wistar , Reproducibility of Results , Treatment Outcome , Tissue Adhesions/prevention & controlABSTRACT
Peritoneal adhesion is one of the common complications of abdominal and pelvic operations,the impact of which is immense in terms of human suffering and substantial socio-economic burden.There is an urgent need for a more effective understanding of the disease process and its etiology,to evaluate the pharmacologic,mechanical,and surgical adjuvant strategies to minimize peritoneal adhesion formation.
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Postoperative peritoneal adhesion represents a major complication of surgery. Recently, the angiogenesis which cyclooxygenase-2 enzyme induced was found to play an important role in the adhesion synthesis. This review summarized the relationship between COX-2 induced angiogenesis and peritoneal ad- hesion.
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Objective To investigate the effects of high molecular bio-degradable film on preventing peritoneal adhesion.Methods One hundred and twenty rats were divided into control group,non-bio-degradable film group and polycaprolactone(PCL) group.Animal models of peritoneal adhesion made by operations on rats serve as control group.In the study,non-bio-degradable film and bio-degradable,namely PCL films sensitive to pseudomonas enzyme,were put into the opening of peritoneum.The effect of the films on peritoneal adhesion was examined on 1,3,7 and 30 d after operation.Results Peritoneal adhesion was found in all the rats of control group and very low in PCL group and non-bio-degradable film group.Conclusion PCL film can effectively prevent the formation of postoperative peritoneal adhesion.
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@#ObjectiveTo study the effect of aprotinin and tumor necrosis factor alpha(TNF-α) antibody on preventing postoperative abdominal adhesion in mice.Methods96 BALB/c mice were randomly divided into 4 groups:normal saline group(n=24),aprotinin group(n=24),TNF-α antibody group(n=24),and aprotinin combined with TNF-α antibody group(n=24).After an identical peritoneal injury operation,all mice were treated intraperitoneally with normal saline , aprotinin,TNF-α antibody and aprotinin combined with TNF-α respectively at the time of abdominal closure .The mice were killed 20 days after operation,the abdominal incisions and the development of intraabdominal adhesions were observed.Adhesion score was based on an overall assessment of the extent,location,and type of adhesions .ResultsAprotinin combined with TNF-α antibody group showed significantly lower adhesion score and 2-3 grade adhesion(advanced significant adhesion) rate was lower than that of other groups(P<0.01).Conclusions The intraperitoneal administration of aprotinin and TNF-α antibody can inhibit postoperative adhesion formation.
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Objective To assess the ability of interleukin-1 beta (IL-1?) antibody and tumor necrosis factor alpha (TNF?) antibody to prevent postoperative abdominal adhesion formation in mice.Methods 60 BALB/c mice were randomly divided into four groups: normal saline group(n=15), anti-IL-1? group(n=15), anti-TNF? group(n=15),and anti-IL-1? combined with anti-TNF? group(n=15). After an identical peritoneal injury operation, mice were treated using intraperitoneally with either normal saline or corresponding antibody at the time of abdominal closure. The mice were killed 20 days after operation, the abdominal incisions and the development of intra-abdominal adhesions were observed. Adhesion scoring was based on an overall assessment of the extent,location, and type of adhesion.Results Anti-IL-1? combined with anti-TNF? group had significantly lower adhesion scores (0 84?0 19) than that in other groups(P
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Objective To explore the effect of chitosan on the prevention of postoperative peritoneal adhesion. Methods Forty-five Wistar rats were randomly assigned into group A(control group);group B and group C;2 ml of 1% lactic acid, 32% Dextran-70 or 2% Chitosan-lactic acid (CLA) was admitted on the region of serosal injury of intestine respectively during operation. The adhesive degree was observed and biopsy was taken on the 14th postoperative day. Results There were statistically significant differences among the degrees of adhesions between the three groups (P
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Objective To investigate the way of closed establishment of pneumoperitoneum(CEPP) in patients with peritoneal cvity adhesion in laparoscopy cholecystectomy(LC). Methods CEPP experiences of 1046 patients in 6600 cases LC in our hospital from September 1991 to September 1999 were retrospectively analysed. The difficulty in establishing pneumoperitoneum was divided into two kinds: real establishment pneumoperitoneal difficulty(REPPD) and false establishment pneumoperitoneal difficulty(FEPPD). REPPD was due to Veress needle penetrating into visceral or extensive adhesion in peritoneal cavity resulting in CO2 flowing into difficulty. FEPPD was due to Veress needle pentrating in the fat out of peritoneum, in round hepatic ligament or in greater omentum. The formal situation needed to open laparotomy as a change, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle penetrating direction or depth in the second penetration. Results Of the 1046 patients, 1028 cases had been establishedpneumoperitoneum successfully though CEPP; 6 cases of REPPD and 18 of FEPPD were required opening laparotomy as a change. The successful rate of CEPP was 98.3%. Conclusions CEPP is a safe and feasible method in patients with peritoneal adhesion in LC. It is the main reason for CEPP failure regarding REPPED as FEPPD made by the deficiency in LC experience and loss confidence in laparoscopist.
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Peritoneal adhesion is one of the most common cause of intestinal obstruction in most parts of the world. In 1989, Thompson and others proposed reduced peritoneal plasminogen activating activity as a possible mechanism of adhesion formation. We used adult Sprague-Dawley rats weighing between 250~350 gm of both sexes. An ether jar was used to induce anesthesia, and a 15 to 20 mg intramuscular injection of ketamine into the hind leg was used to maintain anesthesia. The rat was fixed supine on a rat board, its midabdomen shaved, and povidone-iodine applied. Then the abdomen was opened using Metzenbaum scissors and 2.5 2.5 cm2 area of the parietal peritoneum was abraded in the flank area, left or right side, using sterilized electro-surgical tip cleaner until the preperitoneal fat layer was completely destroyed and blood ooze was emitted from the burst capillaries. The procedure lasted 2~3 minutes. Then, the animals were randomly selected either to apply topically one cc of saline as a control group or to apply drugs dissolved in one cc of saline as on experimental groups. The drugs were disodium cromolycate, verapamil, and urokinase. Disodium cromolycate was used 3 mg/animal, verpamil 0.5 mg, and urokinase 2,000 units/on the animal. The same drugs and the same amounts were used at the same site topically on the 2nd and the 3rd postoperative days without anesthesia by using smooth-tipped needle. Then the animals were examined on the 7th postoperative day under ether anesthesia to find adhesion formations and to grade them into no adhesion, mild, moderate, or severe adhesions according to severity of the adhesions. We used about 15 animals in each group. The results for the peritoneal adhesions were expressed as present or not present to compare the presence of adhesion between the control group and the study groups. The Chi-square test was used, and p values below 0.05 were regarded as significant. In the control rats, there were no adhesions in 3 animals, and adhesions in 12 animals. In the disodium cromolycate-treated groups, there were no adhesions in 8 and adhesions in 8 rats, indicating less frequent adhesion formation, but the p value was 0.081. In the verapamil group, the ratio of no adhesion to adhesion was 4 : 11 which was almost the same as that of the control group(p=0.666). However, in the urokinase group, the ratio was 8 : 6 and the p value was 0.039, so the effects are ignificantly different. With these result, we can conclude that intraperitoneal topical application of urokinase is effective in prevention of rat peritoneal adhesion formation. The effect of disodium cromolycate was only marginal. Verapamil was not effective in prevention of peritoneal adhesion in this study.
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Adult , Animals , Humans , Rats , Abdomen , Anesthesia , Capillaries , Ether , Injections, Intramuscular , Intestinal Obstruction , Ketamine , Leg , Needles , Peritoneum , Plasminogen , Povidone-Iodine , Rats, Sprague-Dawley , Urokinase-Type Plasminogen Activator , VerapamilABSTRACT
Objective To investigate the way of closed establishment of pneumoperitoneum(CEPP) in patients with peritoneal cvity adhesion in laparoscopy cholecystectomy(LC). Methods CEPP experiences of 1?046 patients in 6?600 cases LC in our hospital from September 1991 to September 1999 were retrospectively analysed. The difficulty in establishing pneumoperitoneum was divided into two kinds: real establishment pneumoperitoneal difficulty(REPPD) and false establishment pneumoperitoneal difficulty(FEPPD). REPPD was due to Veress needle penetrating into visceral or extensive adhesion in peritoneal cavity resulting in CO 2 flowing into difficulty. FEPPD was due to Veress needle pentrating in the fat out of peritoneum, in round hepatic ligament or in greater omentum. The formal situation needed to open laparotomy as a change, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle penetrating direction or depth in the second penetration. Results Of the 1?046 patients, 1?028 cases had been establishedpneumoperitoneum successfully though CEPP; 6 cases of REPPD and 18 of FEPPD were required opening laparotomy as a change. The successful rate of CEPP was 98.3%. Conclusions CEPP is a safe and feasible method in patients with peritoneal adhesion in LC. It is the main reason for CEPP failure regarding REPPED as FEPPD made by the deficiency in LC experience and loss confidence in laparoscopist.