Effect Of Fe～(3+) Modify Sodium Carboxymethyl Celluloseon Postoperative Peritoneal Adhesion And Its Experiment

The incidence of the intestinal adhesion after abdominal operation is as high as 90%, so the intestinal adhesion is still one of the more common complications although with advancement in science and improvement in surgical operation. One study has showed that 1.2-3.6% of the patients who receive abdominal operation will be re-operated just because of intestinal adhesion. For more severe case, mesenteriopexy in needed. This is a very big personal and social problem. Therefore, how to prevent intestinal adhesion and obstruction after abdominal operation is one of the question which most surgeon pay attention to.To prevent the postoperative peritoneal adhesion, we must understand the mechanism of the peritoneal adhesion firstly. Under normal conditions, the release of fibrinogenase of the peritoneal mesothelium cells and fibrinolysis is kept balance, but the balance may be interrupted by the mechanical incision, tissue ischemia, exogenous material implantation and peritonitis, which makes the release of fibrinogenase increased and the activity of plasminogen activator decreased, resulting in lots of fibrin deposition and organization and formation of fibrous adhesion eventually. Therefore, the main measurement in prevention of the postoperative peritoneal adhesion is to reduce mechanical incision by careful operation; to prevent tissue ischemia by maintaining well blood supply; to diminish inflammatory reaction by some medicine. The researcher had developed many supplementary measurements to prevent the postoperative peritoneal adhesion. For example, to prevent fibrin deposition by the heparin to promote fibrinolysis by rt-Pa, to restrain the proliferation of fibroblast by chitoscan, but the measurements are not very effective for some reasons.It is verified that the effective contact of serious coat is necessary to form adhesion under the pathological state, many researchers had tried to utilize the local isolation materials (including membranous or liquid) to prevent the postoperative peritoneal adhesion, but the methods can not be applied effectively, because the uncontrollable retain in the peritoneal cavity and the toxic and side-effect of the material itself.With the development of biological medicine, synthesis of biodegradable macromolecule material and it's application has become one of the hot-spots, which provide the developing direction in using the local isolation material to prevent the peritoneal adhesion. The material of preventing postoperative peritoneal adhesion should have the specific properties: 1. very well biocompatibility. 2. no toxic and side-effect. 3. completely degraded in the body with the Changchun Application Chemical Research Institute some kinds of the biodegradable macromolecule materials with the properties mentioned above. First, the intestinal adhesion model in rats was established on the basis of this, the experiment was performed with different kinds of macromolecule materials and found that the most effective material is Fe³⁺ modify sodium carboxymethyl cellulose; the most effective density is 3%; the most effective dose is 45mg/Kg.Based on the premier job, we continue to design and do the following experiments: Objective To study the mechanism of Fe³⁺-CMC preventing postoperative peritoneal adhesion. Methods: 1. Measuring the variation of WBC to evaluate the effectiveness of Fe³⁺-CMC preventing postoperative inflammatory response; 2. To evaluate the efficacy Fe³⁺-CMC preventing postoperative adhesion by eye and microscopic observation, and observing the histological changing of adhesive tissue. 3. Measuring the expression of sIL-2R of adhesion tissue, then observing the effectiveness of Fe³⁺-CMC. 4. Obersving the foundational variation of all kinds of cells in adhesive tissue by transmission electron microscopy. Results: 1. The amount of WBC in the serum of experimental group is more than that of control group (α<0.025). 2. The adhesion extent of experimental group is less than that of control group. it can be observed that the deposition of collagen and inflammatory response of adhesion tissue is lower in experimental group than that of control group. 3. The expression of sIL-2R in adhesive tissue of experimental group is less than that of control group (α<0.05). It certifies that Fe³⁺-CMC can prevent the expressing of sIL-2R. 4. The foundation of macrophage and fibroblast is lower in experimental group than that lf control group. Conclusion: The mechanism of Fe³⁺-CMC preventing postoperative adhesive may be: 1. The excellent local mechanical isolation effectiveness; 2. Fe³⁺-CMC can prevent postoperative acute inflammatory response and decrease the level of WBC in the serum. 3. Fe³⁺-CMC can decrease the permeating of local inflammatory cells and the depositing of collagen, and promoting injured abdominal membrane physiological repairing. 4. Fe³⁺-CMC can prevent the synthesis and expression of TNF-αafter abdominal operation. 5. Fe³⁺-CMC can prevent the synthesis and expression of sIL-2R after abdominal operation.