Gastrotomy followed by gastrorrhaphy as a reliable and more physiologic technique for inducing peritoneal adhesion in rats / Gastrotomia seguida de gastrorrafia, uma técnica mais confiável e fisiológica para a indução de aderências peritoneais em ratos

ABSTRACT Objective: this research objective was to develop a new peritoneal adhesion animal model that would lead to adhesions formation in all operated animals, simple and reproducible, associated with maintenance the animal's health. Methods: eighteen adult male Wistar rats (Rattus norvegicus) were randomly distributed into three groups: Control Group (anatomical and clinical parameters), Sham Group (delicate manipulation of the stomach and exposure of the peritoneal cavity to ambient air) and Surgery Group (gastrotomy followed by gastrorrhaphy). The animals were analyzed and classificated macroscopically according to two adhesion classification models and differences between groups were considered significant when p<0.05. Results: the six animals in the control group had no peritoneal adhesions, three of the six animals in the sham group had focal peritoneal adhesions, and all animals in the surgery group (gastrotomy followed by gastrorraphy) had firm peritoneal adhesions. All adhesions found were macroscopically quantified and microscopically confirmed, without carrying out a microscopic classification of the adhesions. Conclusion: the new model developed of gastrotomy followed by gastrorrhaphy, proved to be safe and efficient to induce and study peritoneal adhesions.

RESUMO Objetivo: o objetivo deste estudo foi criar um novo modelo animal de indução de aderências peritoneais capaz de levar à formação de aderências em todos os animais operados, simples e reprodutível, associado a manutenção da saúde dos animais. Métodos: Dezoito ratos machos, adultos, da linhagem Wistar (Rattus norvegicus) foram distribuídos aleatoriamente em três grupos: Grupo Controle (parâmetro anatômico e clínico), Grupo Sham (manipulação delicada do estômago e exposição de cavidade peritoneal ao ar ambiente) e Grupo Cirurgia (gastrotomia seguida de gastrorrafia). Os animais foram submetidos à análise e classificação macroscópicas, seguindo dois modelos de classificação de aderências. As diferenças entre os grupos foram consideradas estatisticamente significantes se p<0,05. Resultados: os seis animais do grupo controle não apresentavam aderências peritoneais, três dos seis animais do grupo sham apresentavam aderências peritoneais focais e todos os seis animais do grupo cirurgia (gastrotomia seguida de gastrorrafia) apresentavam aderências peritoneais firmes. Todas as aderências encontradas foram quantificadas macroscopicamente e confirmadas microscopicamente, sem a realização de classificação microscópica das aderências. Conclusão: o novo modelo desenvolvido, de gastrotomia seguida de gastrorrafia, mostrou-se seguro e eficiente para induzir e estudar aderências peritoneais.

Experimental evaluation of the use of starch and carboxymethylcellulose in the prevention of intraperitoneal adhesions in hernia surgery with coated meshes

ABSTRACT Purpose: Laparoscopic hernia repair involves a risk of adhesion between coated mesh and viscera. Plant polysaccharides such as starch and carboxymethylcellulose (SC) make up a product that acts as a barrier and prevents intraperitoneal adhesions. This study aimed to evaluate whether topical SC can also reduce adhesions between mesh and intra-abdominal organs. Methods: Forty rats each received placement of two intraperitoneal mesh fragments, one on each side of the abdominal wall. Randomly, 20 animals received SC on the right and other 20 on the left, leaving the contralateral side as a control. Fourteen days after the surgery, the animals underwent an additional laparotomy in which macroscopic analysis was performed. Results: As for the percentage of the mesh area affected by adhesion, one (2.6%) animal had > 75% adhesion on the experimental side, and 11 animals (28.9%) on the control side. The adhesion intensity score showed firm adhesions in three (7.9%) animals on the experimental side and nine (23.7%) on the control side. Conclusions: The use of SC decreased the intensity of adhesions and the surface area of the mesh affected by adhesions. There was no negative interference of the product in the incorporation of the mesh into the abdominal wall.

CT-guided diagnosis of banded vs membranaceous adhesive small bowel obstruction / 中华普通外科杂志

Objectives:To study the computed tomography features of banded adhesions(BA) and matted adhesions(MA) of adhesive small bowel obstruction(ASBO).Methods:We enrolled 150 patients operated on for ASBO. According to intraoperated findings, ASBO were classified into those caused by BA or MA. A multivariable logistic regression was established to analyze independent risk factors on Computed Tomography features.Results:There were significant differences in closed-loop sign (36.8% vs. 14.3%, P=0.002) mesenteric haziness (43.7% vs. 17.5%, P=0.001), beak sign (48.3% vs. 17.5%, P<0.001), fat notch sign (39.1% vs. 9.5%, P<0.001) and peritoneal fluid (54.0% vs. 34.9%, P=0.015) between the two groups. The presence of beak sign [ OR=6.15, 95% CI (2.55-14.84), P<0.001], fat notch sign [ OR=6.19, 95% CI (2.16-17.82), P=0.001] and mesenteric haziness [ OR=3.34, 95% CI (1.34-8.32), P=0.009] were independent risk factors with BA. Conclusion:Beak sign, fat notch sign and mesenteric haziness were independent risk factors for diagnosing BA.

Diseño y validación de una herramienta para la predicción de desenlaces adversos en pacientes con obstrucción intestinal por bridas: La escala HALVIC / Design and validation of a predicting adverse outcomes toll for patients with adhesive small bowel obstruction: HALVIC score

Introducción. La obstrucción intestinal por bridas representa una causa común de consulta a los servicios de urgencias, pero hay poca claridad sobre qué pacientes tienen mayor riesgo de desarrollar complicaciones. El objetivo de este estudio fue diseñar y validar una escala de predicción de riesgo de desenlaces adversos en pacientes con obstrucción intestinal por bridas. Métodos. Estudio de cohorte retrospectivo realizado a partir de la base de datos MIMIC-IV. Se incluyeron pacientes adultos admitidos al servicio de urgencias entre 2008 y 2019, con diagnóstico de obstrucción intestinal por bridas. El desenlace principal fue el compuesto de resección intestinal, ingreso a unidad de cuidados intensivos y mortalidad por cualquier causa. Se diseñó una escala de predicción de riesgo asignando un puntaje a cada variable. Resultados. Se incluyeron 513 pacientes, 63,7 % hombres. El desenlace compuesto se presentó en el 25,7 % de los casos. La edad, historia de insuficiencia cardiaca y enfermedad arterial periférica, nivel de hemoglobina, recuento de leucocitos e INR constituyeron el mejor modelo de predicción de estos desenlaces (AUC 0,75). A partir de este modelo, se creó la escala simplificada HALVIC, clasificando el riesgo del desenlace compuesto en bajo (0-2 puntos), medio (3-4 puntos) y alto (5-7 puntos). Conclusión. La escala HALVIC es una herramienta de predicción simple y fácilmente aplicable. Puede identificar de manera precisa los pacientes con obstrucción intestinal por bridas con alto riesgo de complicaciones, permitiendo el ajuste individualizado de las estrategias de manejo para mejorar los desenlaces

Introduction. Adhesive Small Bowel Obstruction (ASBO) represents a common cause of consultation to the emergency department. Currently there is little clarity about which patients with ASBO are at increased risk of developing complications, potentially benefiting from early surgical management. The present study aims to design and validate a risk prediction scale for adverse outcomes in patients with ASBO. Methods. Retrospective cohort study performed from the MIMIC-IV database between 2008 and 2019. Adult patients admitted to the emergency department with a diagnosis of ASBO were included. The primary outcome was the composite of bowel resection, intensive care unit admission, and all-cause mortality. A risk prediction scale was designed by assigning a score to each variable according to the measure of association obtained in the logistic regression model. All analyses were performed in R statistical software (version 3.5.3). Results. Five-hundred-thirteen patients were included (men 63.7%, median age: 61 years). Composite outcome was present in 25.7% of cases. Age, history of heart failure and peripheral arterial disease, hemoglobin level, leukocyte count, and INR were the best predictors of these outcomes (AUC 0.75). Based on this model, the simplified HALVIC scale was created, classifying the risk of the composite outcome as low (0-2 points), medium (3-4 points) and high (5-7 points). Conclussion. The HALVIC scale is presented as a simple and easily applicable predictive tool in the clinical setting, which can accurately identify patients with ASBO at high risk of complications, allowing the surgeon to adjust management strategies individually and potentially improving the outcomes of these patients

Obstrucción intestinal por adherencias: un lienzo en blanco en el que el cirujano elige los colores / Intestinal obstruction due to adherences: a blank canvas on which the surgeon chooses the colors

Introducción. La obstrucción intestinal es una patología de alta prevalencia. Su abordaje diagnóstico y terapéutico ha evolucionado acorde con el avance del conocimiento e implementación de la tecnología. El impacto de sus complicaciones obliga a redoblar esfuerzos en pro de lograr una mayor efectividad. Se hizo una aproximación reflexiva al problema, mediante una identificación de los puntos controversiales de interés para el cirujano general. Métodos. Se realizó una búsqueda sistemática de la literatura en varias bases de datos, utilizando dos ecuaciones de búsqueda que emplearon términos seleccionados a partir de los tesauros "Medical Subject Heading" (MeSH) y "Descriptores en Ciencias de la Salud" (DeCS). Resultados. Se recolectaron 43 artículos y a partir de ellos se construyó el texto de revisión. La identificación pronta de los posibles candidatos a cirugía, mediante un esquema diagnóstico y terapéutico, se constituye en una prioridad en el manejo de estos pacientes. De igual manera, se efectúan consideraciones en la toma de decisiones con respecto a la vía quirúrgica, así como recomendaciones técnicas operatorias producto de la experiencia y lo reportado en la literatura. Existen factores propios del cirujano, del contexto y del paciente, que inciden en la resolución del problema. Conclusión. La obstrucción intestinal y sus implicaciones clínicas obligan a una reevaluación constante de su estado del arte y avances en el manejo, tendiente a una búsqueda de oportunidades para impactar favorablemente en su curso clínico. Hay estrategias por implementar, inclusive el manejo laparoscópico en casos seleccionados

Introduction. Intestinal obstruction is a pathology of high prevalence. Its diagnostic and therapeutic approach has evolved according to the progress in knowledge and implementation of technology. The impact of its complications makes it necessary to make the efforts to achieve higher effectiveness. A reflexive approach to the problem is made by identifying the controversial points of interest for the general surgeon. Methods. A systematic literature search was carried out in several databases, using two search equations from the review performed in the thesaurus "Medical Subject Heading" (MeSH) and "Descriptors in Health Sciences" (DeCS). Results. A total of 43 articles were collected using the selected methods and the review text was constructed from them. The early identification of possible candidates for surgery, by means of a diagnostic and therapeutic algorithm, is a priority in the management of these patients. Likewise, considerations are made in decision-making regarding the laparoscopic vs. traditional approach, as well as operative technical recommendations based on experience and what has been reported in the literature. There are factors specific to the surgeon, the context and the patient that influence the resolution of the problem. Conclusion. Intestinal obstruction and its clinical implications require a constant reevaluation of the state of the art and advances in management, tending to search for opportunities to favorably impact its clinical course. There are strategies to be implemented, including laparoscopic management in selected cases

Application of ultrasound-guided adhesiolysis combined with platelet-rich plasma in the treatment of rotator cuff injuries / 中国基层医药

Objective:To investigate the efficacy of ultrasound-guided adhesiolysis combined with platelet-rich plasma in the treatment of rotator cuff injuries.Methods:The clinical data of 103 patients with rotator cuff injuries treated in The 72 nd Military Hospital of PLA from December 2017 to December 2019 were retrospectively analyzed. The patients were divided into two groups according to the treatment methods. The control group ( n = 48) was treated with ultrasound-guided adhesiolysis. The study group ( n = 55) was treated with ultrasound-guided adhesiolysis and intra-articular injection of platelet rich plasma. Therapeutic effects, pain score, shoulder function score, shoulder range of motion, healing rate, and re-tear rate were compared between the control and study groups. Results:Total effective rate was significantly higher in the study group than in the control group (96.36% vs. 81.25%, χ2 = 6.14, P < 0.05). Pain score in each group was significantly decreased after treatment compared with before treatment [study group: (1.69 ± 0.81) points vs. (6.13 ± 1.28) points; control group: (3.22 ± 1.05) points vs. (6.13 ± 1.28) points, t = 31.510, 8.33, both P < 0.001]. The University of California at Los Angeles (UCLA) shoulder score in each group was significantly increased after treatment compared with before treatment [study group: (33.26 ± 3.81) points vs. (14.03 ± 2.96) points; control group: (28.81 ± 3.20) points vs. (13.92 ± 3.03) points, t = 42.13, 33.12, both P < 0.001]. Constant-Murley Score in each group was significantly increased after treatment compared with before treatment [study group: (94.22 ± 4.15) points vs. (55.29 ± 8.18) points; control group: (82.11 ± 8.13) points vs. (56.33 ± 7.83) points; t = 46.83, 22.38, both P < 0.001]. After treatment, pain score was significantly lower in the study group than in the control group [(1.69 ± 0.81) points vs. (3.22 ± 1.05) points, t = 8.33, P < 0.001]. UCLA score and CMS were significantly higher in the study group than in the control group [(33.26 ± 3.81) points vs. (28.81 ± 3.20) points, (94.22 ± 4.15) points vs. (82.11 ± 8.13) points, t = 6.37, 9.70, both P < 0.001]. After treatment, there were improvements in flexion [study group: (159.26 ± 13.51)° vs. (85.26 ± 11.35)°; control group: (150.22 ± 14.35)° vs. (86.33 ± 11.51)°; t = 45.15, 34.23, both P < 0.001], internal rotation at 90° abduction [study group: (83.64 ± 5.29)° vs. (60.33 ± 4.12)°; control group: (76.81 ± 4.82)° vs. (60.61 ± 4.51)°; t = 36.74, 24.06, both P < 0.001], abduction [study group: (161.29 ± 10.76)° vs. (72.91 ± 5.16)°; control group: (152.81 ± 11.84) ° vs. (73.26 ± 5.22)°; t = 82.34, 64.61, both P < 0.001], external rotation at 90° abduction [study group: (87.82 ± 3.04)° vs. (4.29 ± 5.18)°; control group: (80.22 ± 4.13)° vs. (80.22 ± 4.13)°; t = 42.46, 21.55, both P < 0.001] , and external rotation in neutral position [study group: (43.18 ± 3.20)° vs. (22.85 ± 4.12)°; control group: (37.26 ± 4.12)° vs. (22.64 ± 3.95)°; t = 41.19, 25.10, both P < 0.001] in each group compared with before treatment. After treatment, range of motion of the shoulder in the above positions was significantly higher in the study group than in the control group [flexion: (159.26 ± 13.51)° vs. (150.22 ± 14.35)°; internal rotation at 90° abduction: (83.64 ± 5.29)° vs. (76.81 ± 4.82)°; abduction: (161.29 ± 10.76)° vs. (152.81 ± 11.84)°; external rotation at 90° abduction: (87.82 ± 3.04)° vs. (80.22 ± 4.13)°; external rotation in neutral position: (43.18 ± 3.20)° vs. (37.26 ± 4.12)°, t = 3.29, 6.81, 3.81, 10.72, 8.20, all P < 0.001]. There was no significant difference in healing rate between the study and control groups (1.82% vs. 16.67%, χ2 = 5.35, P < 0.05). Conclusion:Ultrasound-guided adhesiolysis combined with platelet-rich plasma is highly effective in the treatment of rotator cuff injuries because it can greatly improve shoulder function, reduce pain degree, and increase the range of motion of the shoulder.

Use of hypertonic glucose (10%) in the prevention of postoperative adhesions in rats

ABSTRACT Purpose To evaluate the efficacy of hypertonic glucose (10%), alone or in combination with the corticoid dexamethasone, to prevent peritoneal adhesion following hysterectomy in rats. Methods Forty-two adult rats underwent hysterectomy with peritoneal lavage: G1 - glucose (10%); G2 - glucose (10%) and dexamethasone 3 mg·kg-1; and G3 - physiological saline (PS) 0.9%. Results In the macroscopic analysis after 14 days, G1 had a median score of 1, G2 of 1, and G3 of 2.5 (p < 0.0001), G3 compared to G1 and G2. There was no difference between groups after 28 days. In the microscopic analysis, the median vascular proliferation after 14 days was 2 for G1, 1 for G2, and 3 for G3 (p = 0.0037, G3 vs. G1 and G2). After 28 days, G1 showed a median vascular proliferation score of 2, G2 of 2.5, and G3 of 3 (p < 0.0001, G3 vs. G1 and G2). Regarding the inflammatory reaction after 14 days, G1 had a median score of 2, G2 of 1, and G3 of 3 (p = 0.7916). After 28 days, G1 had a median score of 0.5 (0-1.75), G2 of 1.5, and G3 of 2.5 (p < 0.0001, G3 vs. the others and G2 vs. G1). In the evaluation of fibrosis after 14 days, G1 had a median score of 1, G2 of 1, and G3 of 2.5 (p < 0.0001, G3 vs. G1and G2). After 28 days, G1 had a median fibrosis score of 1, G2: 2, and G3: 2.5 (p < 0.0001), G3 vs. the others andG2 vs. G1). Conclusions The use of hypertonic glucose (10%) solution seems to reduce macroscopic and microscopic pelvic adhesions.

Application of optical trocar insertion in laparoscopic surgery after previous abdominal surgery / 临床肝胆病杂志

Objective To investigate the value of optical trocar insertion technique in establishing pneumoperitoneum in patients undergoing laparoscopic surgery after previous abdominal surgery. Methods A total of 29 patients, with a history of abdominal surgery, who planned to undergo laparoscopic liver surgery were enrolled and randomly divided into optical trocar insertion group and open approach group. The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the Fisher's exact test was used for comparison of categorical data between groups; the Mann-Whitney U test was used for comparison of ranked data between groups. Results There were no procedure-related complications in either group. Compared with the open approach group, the optical trocar insertion group had a significantly shorter time required to establish pneumoperitoneum [35.00 (21.00-46.00) seconds vs 180.00 (152.50-252.50) seconds, U =0, P < 0.001] and a significantly smaller incision length [1.10(1.00-1.20) cm vs 2.80(2.45-3.00) cm, U =0, P < 0.001]. Conclusion Both optical trocar insertion and open approach for establishing pneumoperitoneum is relatively safe in patients undergoing laparoscopic liver surgery after previous abdominal surgery, while optical trocar insertion has the advantages of high efficiency and minimal invasiveness in establishing pneumoperitoneum.

Application of optical trocar insertion in laparoscopic surgery after previous abdominal surgery / 临床肝胆病杂志

Objective To investigate the value of optical trocar insertion technique in establishing pneumoperitoneum in patients undergoing laparoscopic surgery after previous abdominal surgery. Methods A total of 29 patients, with a history of abdominal surgery, who planned to undergo laparoscopic liver surgery were enrolled and randomly divided into optical trocar insertion group and open approach group. The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the Fisher's exact test was used for comparison of categorical data between groups; the Mann-Whitney U test was used for comparison of ranked data between groups. Results There were no procedure-related complications in either group. Compared with the open approach group, the optical trocar insertion group had a significantly shorter time required to establish pneumoperitoneum [35.00 (21.00-46.00) seconds vs 180.00 (152.50-252.50) seconds, U =0, P < 0.001] and a significantly smaller incision length [1.10(1.00-1.20) cm vs 2.80(2.45-3.00) cm, U =0, P < 0.001]. Conclusion Both optical trocar insertion and open approach for establishing pneumoperitoneum is relatively safe in patients undergoing laparoscopic liver surgery after previous abdominal surgery, while optical trocar insertion has the advantages of high efficiency and minimal invasiveness in establishing pneumoperitoneum.

Biomechanical and adhesion comparison of linea alba prophylactic reinforcement with coated and uncoated three-dimensional T-shaped mesh in rabbits

Abstract Purpose: Incisional hernia (IH) is a frequent complication of median laparotomy. The use of prophylactic mesh to reduce IH incidence has gained increasing attention. We hypothesized that in an animal model, linea alba prophylactic reinforcement with a three-dimensional T-shaped polypropylene mesh results in greater abdominal wall resistance. Methods: Study was performed in 27 rabbits. After abdominal midline incision, animals were divided into three groups according to the laparotomy closure method used: (1)3D T-shaped coated mesh; (2)3D T-shaped uncoated mesh; and (3) closure without mesh. After 4 months, each animal's abdominal wall was resected and tensiometric tests were applied. Results included IH occurrence, adhesions to the mesh, and wound complications. Results: There was no significant difference between the groups in maximum tensile strength (p=0.250) or abdominal wall elongation under maximum stress (p=0.839). One rabbit from the control group developed IH (p=1.00). Small intestine and colon adhesions occurred only in the uncoated mesh group (p<0.001) and the degree of adhesions was higher in this group compared to the coated mesh group (p<0.05). Conclusion: Use of the current 3D T-shaped prophylactic mesh model did not result in a significant difference in tensiometric measurements when compared with simple abdominal wall closure in rabbits.

Comparison of the effect of traditional hysteroscopy and HEOS system hysteroscopy in the treatment of refractory intrauterine residual / 中国基层医药

Objective@#To compare the clinical effects of conventional hysteroscopy and HEOS hysteroscopy in the treatment of refractory intrauterine residuals.@*Methods@#From January 2017 to February 2019, 60 patients with refractory intrauterine pregnancy residuals admitted to the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou were randomly selected.The patients were divided into traditional endoscopy group and HEOS system endoscope group according to the different operation method, with 30 cases in each group.The operation time, intraoperative blood loss, hospitalization cost, postoperative uterine adhesion rate, postoperative menstrual recovery time, postoperative recovery rate of endometrium at the first, second and third month after operation were compared between the two groups.@*Results@#The operation time of the conventional laparoscopic group was (24.38±3.16)min, which was longer than that of the HEOS system hysteroscopy group[(18.71±3.32)min](t=1.336, P=0.027). The intraoperative blood loss of the conventional laparoscopic group was (18.41±4.35)mL, which was higher than that of the HEOS system hysteroscopy group[(12.81±3.84)mL](t=1.853, P=0.031). The hospitalization cost of the conventional laparoscopic group was (7 461.87±344.92)CNY, which was more than that of the HEOS system hysteroscopy group[(6 743.19±298.52)CNY](t=0.037, P=0.040). In addition, the uterine adhesion rate in the traditional hysteroscopic group was 20.00%(6/30), which was higher than that in the HEOS system hysteroscopy group[6.67%(2/30)](χ2=2.308, P=0.029), and the postoperative menstrual recovery time in the traditional hysteroscopic group was (31.46±4.12)d, which was longer than that in the HEOS system hysteroscopy group[(26.18±3.72)d](t=1.730, P=0.026). At the first, second and third month after operation, the good endometrial recovery rates in the traditional laparoscopic group were 20.00%(6/30), 43.33%(13/30), 63.33%(19/30), respectively, which were lower than those in the HEOS system hysteroscopy group[46.67%(14/30), 70.00%(21/30), 93.33%(28/30)](χ2=4.800, 4.344, 7.954, P=0.028, 0.037, 0.005).@*Conclusion@#HEOS system endoscope in the treatment of refractory intrauterine residual has good effect and is worthy of promoting.

Comparison of the effect of traditional hysteroscopy and HEOS system hysteroscopy in the treatment of refractory intrauterine residual / 中国基层医药

Objective To compare the clinical effects of conventional hysteroscopy and HEOS hysteroscopy in the treatment of refractory intrauterine residuals.Methods From January 2017 to February 2019,60 patients with refractory intrauterine pregnancy residuals admitted to the Integrated Traditional Chinese and Western MedicineHospital of Wenzhou were randomly selected .The patients were divided into traditional endoscopy group and HEOS system endoscope group according to the different operation method ,with 30 cases in each group.The operation time, intraoperative blood loss , hospitalization cost , postoperative uterine adhesion rate , postoperative menstrual recovery time,postoperative recovery rate of endometrium at the first ,second and third month after operation were compared between the two groups.Results The operation time of the conventional laparoscopic group was (24.38 ±3.16)min, which was longer than that of the HEOS system hysteroscopy group [(18.71 ±3.32)min](t=1.336,P=0.027). The intraoperative blood loss of the conventional laparoscopic group was (18.41 ±4.35) mL,which was higher than that of the HEOS system hysteroscopy group[(12.81 ±3.84)mL](t=1.853,P=0.031).The hospitalization cost of the conventional laparoscopic group was (7461.87 ±344.92) CNY,which was more than that of the HEOS system hysteroscopy group[(6743.19 ±298.52)CNY](t=0.037,P=0.040).In addition,the uterine adhesion rate in the traditional hysteroscopic group was 20.00％( 6/30 ) , which was higher than that in the HEOS system hysteroscopy group[6.67％(2/30)] (χ2 =2.308,P=0.029),and the postoperative menstrual recovery time in the traditional hysteroscopic group was ( 31.46 ±4.12 ) d, which was longer than that in the HEOS system hysteroscopy group [(26.18 ±3.72)d](t=1.730,P=0.026).At the first,second and third month after operation ,the good endometrial recovery rates in the traditional laparoscopic group were 20.00％(6/30),43.33％(13/30),63.33％(19/30), respectively,which were lower than those in the HEOS system hysteroscopy group [46.67％(14/30),70.00％(21/30),93.33％(28/30)](χ2 =4.800,4.344,7.954,P =0.028,0.037,0.005).Conclusion HEOS system endoscope in the treatment of refractory intrauterine residual has good effect and is worthy of promoting .

Comparative study of four different types of intraperitoneal mesh prostheses in rats

Abstract Purpose: To compare four types of mesh regarding visceral adhesions, inflammatory response and incorporation. Methods: Sixty Wistar rats were divided into four groups, with different meshes implanted intraperitoneally: polytetrafluoroethylene (ePTFE group); polypropylene with polydioxanone and oxidized cellulose (PCD); polypropylene (PM) and polypropylene with silicone (PMS). The variables analyzed were: area covered by adhesions, incorporation of the mesh and inflammatory reaction (evaluated histologically and by COX2 immunochemistry). Results: The PMS group had the lowest adhesion area (63.1%) and grade 1 adhesions. The ePTFE and PM groups presented almost the total area of their surface covered by adherences (99.8% and 97.7% respectively) The group ePTFE had the highest percentage of area without incorporation (42%; p <0.001) with no difference between the other meshes. The PMS group had the best incorporation rate. And the histological analysis revealed that the inflammation scores were significantly different. Conclusions: The PM mesh had higher density of adherences, larger area of adherences, adherences to organs and percentage of incorporation. ePTFE had the higher area of adherences and lower incorporation. The PMS mesh performed best in the inflammation score, had a higher incorporation and lower area of adherences, and it was considered the best type of mesh.

Comparative study of peritoneal adhesions after intraperitoneal implantation in rats of meshes of polypropylene versus polypropylene/polyglecaprone versus polyester/porcine collagen

Abstract Purpose To Compare the extent and intensity of adhesions formed between the intra-abdominal organs and the intraperitoneal implants of polypropylene mesh versus polypropylene/polyglecaprone versus polyester/porcine collagen used for correction of abdominal wall defect in rats. Methods After the defect in the abdominal wall, thirty Wistar rats were placed in three groups (ten animals each) for intraperitoneal mesh implant: polypropylene group, polypropylene/polyglecaprone group, and polyester/porcine collagen group. The macroscopic evaluation of the extent and intensity of adhesions was performed 21 days after the implant. Results The polypropylene group had a higher statistically significant impairment due to visceral adhesions (p value = 0.002) and a higher degree of intense adherence in relation to polypropylene/polyglecaprone and polyester/porcine collagen groups (p value<0.001). The polyester/porcine collagen group showed more intense adhesions than the polypropylene/polyglecaprone group (p value=0.035). Conclusions The intraperitoneal implantation of polypropylene meshes to correct defects of the abdominal wall caused the appearance of extensive and firm adhesions to intra-abdominal structures. The use of polypropylene/polyglecaprone or polyester/porcine collagen tissue-separating meshes reduces the number and degree of adhesions formed.

The advance of materials for preventing adhesion in tympanoplasty / 中华耳鼻咽喉头颈外科杂志

For otitis media patients with severe mucosal lesions, adhesion is the most common poor prognosis of tympanoplasty. We generally consider tympanic cavity adhesion is due to eustachian tube dysfunction and poor middle ear ventilation. The mechanism of adhesion is unclear so far, which we thought is mainly associated with wounded surface and activation of the fibrinolytic system. To solve the problem of adhesion, several materials have been used in the middle ear surgery, such as plastic sheet, silicone sheet and absorbable material. And there are some benefits. The most widely used is silicone sheet, and there are some researches focused on its thickness, shape and components to achieve better anti-adhesion effect. In this article, we will do a review for the research advances of anti-adhesion materials in tympanoplasty.

Effect of intraperitoneally injected dexmedetomidine on abdominal adhesions in rats and the role of cholinergic anti-inflammatory pathway / 中华麻醉学杂志

Objective To evaluate the effect of intraperitoneally injected dexmedetomidine on abdominal adhesions in rats and the role of cholinergic anti-inflammatory pathway.Methods Forty cleangrade healthy adult male Sprague-Dawley rats,weighing 220-250 g,were divided into 4 groups (n =10 each) using a random number table method:sham operation group (Sham group),abdominal adhesion group (AA group),dexmedetomidine group (DEX group) and dexmedetomidine plus methyllycaconitine group (DEX-M group).The rat model of abdominal adhesions was established by cecal friction method.In Sham group,abdominal cavity was only opened and then sutured.Normal saline 2 ml was injected into the abdominal cavity and tail vein in group AA.In DEX and DEX-M groups,normal saline 2 ml and α7 nicotinic acetylcholine receptor antagonist methyllycaconitine 2.4 μg/g (dissolved in 2 ml normal saline) were injected,respectively,and dexmedetomidine 10μg/kg (dissolved in 2 ml normal saline) was intraperitoneally injected at the same time.The abdominal incision was opened under anesthesia at 7 days after establishing the model to observe the formation of abdominal adhesion,Phillips method was used for scoring,and enzyme-linked immunosorbent assay was used to determine the transforming growth factor-beta1 (TGF-β1) concentrations in ascites and tumor necrosis factor-alpha (TNF-α) concentrations in serum.The rats were then sacrificed,and the caecum tissue and its contralateral peritoneum and adhesion fibrous strips were obtained for examination of the pathological changes with a light microscope.Results Compared with group Sham,the abdominal adhesion score and serum TNF-α concentrations were significantly increased in AA and DEX-M groups,and the TGF-β1 concentration in ascites was significantly increased in AA,DEX and DEX-M groups (P＜0.05).Compared with group AA,the serum TNF-α concentrations and TGF-β1 concentration in ascites were significantly decreased in group DEX-M,and the abdominal adhesion score was significantly decreased (P＜0.05),and the pathological changes of caecum tissue,contralateral peritoneum and adhesion fibrous strips were significantly attenuated in group DEX.Compared with group DEX-M,the serum TNF-o concentrations were significantly increased (P＜0.05),no significant change was found in TGF-1 concentration in ascites (P＞0.05),and the pathological changes of caecum tissue,contralateral peritoneum and adhesion fibrous strips were accentuated in group DEX.Conclusion Intraperitoneally injected dexmedetomidine can mitigate abdominal adhesions,and the mechanism is related to activating cholinergic anti-inflammatory pathway and reducing systemic inflammatory response in rats.

Effect of intraperitoneally injected dexmedetomidine on abdominal adhesions in rats and the role of cholinergic anti-inflammatory pathway / 中华麻醉学杂志

Objective@#To evaluate the effect of intraperitoneally injected dexmedetomidine on abdominal adhesions in rats and the role of cholinergic anti-inflammatory pathway.@*Methods@#Forty clean-grade healthy adult male Sprague-Dawley rats, weighing 220-250 g, were divided into 4 groups (n = 10 each) using a random number table method: sham operation group (Sham group), abdominal adhesion group (AA group), dexmedetomidine group (DEX group) and dexmedetomidine plus methyllycaconitine group (DEX-M group). The rat model of abdominal adhesions was established by cecal friction method.In Sham group, abdominal cavity was only opened and then sutured.Normal saline 2 ml was injected into the abdominal cavity and tail vein in group AA.In DEX and DEX-M groups, normal saline 2 ml and α7 nicotinic acetylcholine receptor antagonist methyllycaconitine 2.4 μg/g (dissolved in 2 ml normal saline) were injected, respectively, and dexmedetomidine 10 μg/kg (dissolved in 2 ml normal saline) was intraperitoneally injected at the same time.The abdominal incision was opened under anesthesia at 7 days after establishing the model to observe the formation of abdominal adhesion, Phillips method was used for scoring, and enzyme-linked immunosorbent assay was used to determine the transforming growth factor-beta1 (TGF-β1) concentrations in ascites and tumor necrosis factor-alpha (TNF-α) concentrations in serum.The rats were then sacrificed, and the caecum tissue and its contralateral peritoneum and adhesion fibrous strips were obtained for examination of the pathological changes with a light microscope.@*Results@#Compared with group Sham, the abdominal adhesion score and serum TNF-α concentrations were significantly increased in AA and DEX-M groups, and the TGF-β1 concentration in ascites was significantly increased in AA, DEX and DEX-M groups (P<0.05). Compared with group AA, the serum TNF-α concentrations and TGF-β1 concentration in ascites were significantly decreased in group DEX-M, and the abdominal adhesion score was significantly decreased (P<0.05), and the pathological changes of caecum tissue, contralateral peritoneum and adhesion fibrous strips were significantly attenuated in group DEX.Compared with group DEX-M, the serum TNF-α concentrations were significantly increased (P<0.05), no significant change was found in TGF-β1 concentration in ascites (P>0.05), and the pathological changes of caecum tissue, contralateral peritoneum and adhesion fibrous strips were accentuated in group DEX.@*Conclusion@#Intraperitoneally injected dexmedetomidine can mitigate abdominal adhesions, and the mechanism is related to activating cholinergic anti-inflammatory pathway and reducing systemic inflammatory response in rats.

Barrier materials for postoperative abdonimal adhesion: biological characteristics,merits and demerits / 中国组织工程研究

BACKGROUND: Postoperative abdominal adhesion is one of the most urgent surgical problems. In view of the complicated pathological mechanisms and various risk factors of postoperative adhesion, surgical techniques and barrier materials have increasingly become the focus of postoperative prevention of adhesion. OBJECTIVE: To summarize the pathological mechanisms and risk factors of postoperative abdominal adhesions and to review the material source, biological characteristics, current research status, and potential deficiencies of different types of barrier materials. METHODS: We retrieved PubMed, CNKI, WanFang and VIP databases from their inception dates to January 2018, and "postoperative abdominal adhesion, etiology and pathogenesis, risk factors, preventive measures, barrier materials" were used as the keywords in English and Chinese, respectively. Fifty-four articles were included in final analysis. RESULTS AND CONCLUSION: Anti-adhesion materials can isolate the injured area and peripheral tissues through physical barriers in the early stage of adhesion formation, and thus prevent the formation of abdominal adhesion. There are three types of anti-adhesion barrier material at present, including solution, gel and membrane agents. Each kind of material has its own advantages and disadvantages. Therefore we explore the pathological process of postoperative abdominal adhesions, predict the risk factors of postoperative adhesions, improve surgical skills and select appropriate anti-adhesion barrier materials according to actual conditions, which are expected to reduce the formation of postoperative abdominal adhesions.

The cause of adhesion in cholecystic triangle and its influence on laparoscopic cholecystectomy / 中国医师杂志

The adhesion in the gallbladder triangle is the most important factor influencing the conversion to laparotomy in laparoscopic cholecystectomy (LC).The degree of adhesion in the cholecystic triangle is closely related to the difficulty of LC operation.With the reduction of cholecystic triangle adhesion,the treatment of gallbladder during LC will be easy and the rate of conversion to laparotomy will decrease accordingly.In order to investigate the causes of cholecystic triangle adhesion and its influence on LC,this paper reviews the current research progress.

Hyperbaric oxygenation on adhesions prevention after laparotomy in rats

Abstract Purpose: To evaluate the effects of hyperbaric oxygenation on prevention of adhesions in the abdominal cavity after laparotomy. Methods: Fifty four rats underwent laparotomy; stitches were made in the four quadrant parietal peritoneum and abdominal cavity closure. Animals were divided into three groups: 1 - control; 2 - subjected to high pressures and oxygenation; 3 - subjected to 100% hyperbaric oxygenation. The animals in groups 2 and 3 were daily submitted to oxygenation hyperbaric chamber after surgery. On the seventh day another laparotomy, registration of procedure, assessment of adhesions and biopsies of the peritoneum were held. Professionals analyzed the videos and the biopsies. Results: Peritoneal cavity adhesions occurred in animals of three groups with no difference between them. In Group 3, the adhesions presented more fragile and vascular proliferation more pronounced, and there was no difference in comparison with the first and second groups. However, there was no significant difference in the evaluation of these parameters between the animals in groups 1 and 2. Conclusions: Postoperative hyperbaric oxygenation in rats submitted to laparotomy did not alter the frequency, but reduced the density of adhesions in the peritoneal cavity and promoted vascular proliferation. The change in atmospheric pressure alone had no influence on the results.