بررسي ماكروسكوپيك و ميكروسكوپيك اثر نرمال سالين بر ميزان چسبندگي پس از اعمال جراحي شكمي در نمونه موش صحرايي

Macroscopic and Microscopic Assessment of Normal Saline on Postoperative Adhesion Formation in a Rat Model

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﭼﺴﺒﻨﺪﮔﻲ ﻳﮑﻲ ﺍﺯ ﻣﺸﮑﻼﺕ ﺷﺎﻳﻊ ﭘﺲ ﺍﺯ ﺍﻋﻤﺎﻝ ﺟﺮﺍﺣﻲ ﺷﮑﻤﻲ ﻭ ﻋﺎﻣﻞ ﺩﺭﺻﺪ ﺑﺎﻻﻳﻲ ﺍﺯ ﺑﻴﻤﺎﺭﻱ ﻫﺎﻳﻲ ﻣﺎﻧﻨﺪ: ﺍﻧﺴﺪﺍﺩ ﺭﻭﺩﻩ ﮐﻮﭼﮏ، ﻧﺎﺯﺍﻳﻲ ﻭ ﺩﺭﺩ ﻣﺰﻣﻦ ﻧﺎﺣﻴﻪ ﺷﮑﻤﻲ ﺍﺳﺖ. ﻫﺪﻑ ﺍﺯ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺮﺭﺳﻲ ﺍﺛﺮ ﻣﺤﻠﻮﻝ ﻧﺮﻣﺎﻝ ﺳﺎﻟﻴﻦ ﺩﺭ ﺟﻠﻮﮔﻴﺮﻱ ﺍﺯ ﺍﻳﺠﺎﺩ ﭼﺴﺒﻨﺪﮔﻲ ﭘﺲ ﺍﺯ ﺍﻋﻤﺎﻝ ﺟﺮﺍﺣﻲ ﺷﮑﻤﻲ ﺩﺭ ﻧﻤﻮﻧﻪ ﻣﻮﺵ ﻫﺎﻱ ﺻﺤﺮﺍﻳﻲ ﻣﻲ ﺑﺎﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﺍﻳﻦ ﺗﺤﻘﻴﻖ ﺍﺯ ﺗﻌﺪﺍﺩ 30 ﺳﺮﻣﻮﺵ ﺻﺤﺮﺍﻳﻲ ﻣﺎﺩﻩ ﺑﺎﻟﻎ ﻧﮋﺍﺩ Albino Wistar ﺑﻪ ﻭﺯﻥ 200 -250 ﮔﺮﻡ ﺍﺳﺘﻔﺎﺩﻩ ﮔﺮﺩﻳﺪ. ﻣﻮﺵ ﻫﺎ ﺑﻪ ﺻﻮﺭﺕ ﺗﺼﺎﺩﻓﻲ ﺑﻪ 3 ﮔﺮﻭﻩ 10 ﺗﺎﻳﻲ ﺷﺎﻣﻞ: ﮔﺮﻭﻩ ﻧﺮﻣﺎﻝ ﺳﺎﻟﻴﻦ (NS)، ﮔﺮﻭﻩ ﺷﺎﻫﺪ ﻭ ﮔﺮﻭﻩ ﺑﺪﻭﻥ ﻣﺪﺍﺧﻠﻪ )ﺗﻨﻬﺎ ﺟﻬﺖ ﻣﻘﺎﻳﺴﻪ ﺗﻐﻴﻴﺮﺍﺕ ﻭﺯﻧﻲ(، ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ. ﺟﻬﺖ ﺍﻧﺠﺎﻡ ﻣﻄﺎﻟﻌﻪ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﻋﻤﻮﻣﻲ ﺣﻴﻮﺍﻥ، ﺑﺮﺷﻲ ﺑﻪ ﻃﻮﻝ 3 ﺳﺎﻧﺘﻴﻤﺘﺮ ﺭﻭﻱ ﺧﻂ ﻣﻴﺎﻧﻲ ﺷﮑﻢ ﺩﺍﺩﻩ ﺷﺪ. ﺳﮑﻮﻡ ﻭ ﺳﻄﺢ ﻗﺪﺍﻣﻲ ﻏﺸﺎﻱ ﺳﺮﻭﺯﻱ ﺁﻥ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﮔﺎﺯ ﺍﺳﺘﺮﻳﻞ ﺍﻧﺪﮐﻲ ﺧﺮﺍﺵ ﺩﺍﺩﻩ ﺷﺪ. ﺩﺭ ﮔﺮﻭﻩ ﺷﺎﻫﺪ ﺳﮑﻮﻡ ﭘﺲ ﺍﺯ ﺍﻳﺠﺎﺩ ﺧﺮﺍﺵ( ﺑﻪ ﻣﺪﺕ 1 ﺩﻗﻴﻘﻪ ﺩﺭ ﻫﻮﺍﻱ ﺁﺯﺍﺩ ﻗﺮﺍﺭﮔﺮﻓﺖ ﻭ ﺩﺭ ﮔﺮﻭﻩNS ﻣﻴﺰﺍﻥ 1 ﻣﻴﻠﻲ ﻟﻴﺘﺮ ﻣﺤﻠﻮﻝ ﻧﺮﻣﺎﻝ ﺳﺎﻟﻴﻦ ﺩﺍﺧﻞ ﺣﻔﺮﻩ ﭘﺮﻳﺘﻮﺋﻦ ﺭﻳﺨﺘﻪ ﺷﺪ ﻭ ﺷﮑﻢ ﺑﺴﺘﻪ ﺷﺪ. ﺳﭙﺲ ﺗﻤﺎﻡ ﺣﻴﻮﺍﻧﺎﺕ ﺩﺭ ﺷﺮﺍﻳﻂ ﮐﺎﻣﻼﹰ ﻳﮑﺴﺎﻥ ﺍﺯ ﻟﺤﺎﻅ ﺧﻮﺭﺍﮎ، ﺩﻣﺎ ﻭ ﺭﻃﻮﺑﺖ ﻧﮕﻬﺪﺍﺭﻱ ﻭ ﭘﺲ ﺍﺯ 2 ﻫﻔﺘﻪ ﻣﻌﺪﻭﻡ ﺷﺪﻧﺪ. ﻣﻴﺰﺍﻥ ﭼﺴﺒﻨﺪﮔﻲ ﺩﺭ ﻧﺎﺣﻴﻪ ﺷﮑﻤﻲ ﺍﻳﻦ ﺣﻴﻮﺍﻧﺎﺕ ﺍﺯ ﺩﻭ ﻃﺮﻳﻖ ﻣﺸﺎﻫﺪﻩ ﻣﺎﮐﺮﻭﺳﮑﻮﭘﻲ ﻭ ﺑﺮﺭﺳﻲ ﭘﺎﺗﻮﻟﻮﮊﻳﮏ ﺑﻮﺳﻴﻠﻪ ﺭﻧﮓ ﺁﻣﻴﺰﻱ ﻫﻤﺎﺗﻮﻛﺴﻴﻠﻴﻦ ﺍﺋﻮﺯﻳﻦ ﺍﺭﺯﻳﺎﺑﻲ ﺷﺪ. ﺩﺭ ﺗﺠﺰﻳﻪ ﻭ ﺗﺤﻠﻴﻞ ﺍﻃﻼﻋﺎﺕ ﺍﺯ ﺁﺯﻣﻮﻥ ﻏﻴﺮ ﭘﺎﺭﺍﻣﺘﺮﻳﮏ Kruskal-Wallis ﻫﻤﺮﺍﻩ ﺑﺎ ﺁﻧﺎﻟﻴﺰﺁﻣﺎﺭﻱ Mann-Whitney U ﻭ ﺍﺯ ﻧﺮﻡ ﺍﻓﺰﺍﺭ SPSS 13.5 ﺍﺳﺘﻔﺎﺩﻩ ﮔﺮﺩﻳﺪ ﻭ ﺍﺧﺘﻼﻑ ﻣﻌﻨﺎﺩﺍﺭﻱ ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ P- value≤ 0.05 ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻣﺸﺎﻫﺪﺍﺕ ﻣﺎﮐﺮﻭﺳﮑﻮﭘﻲ ﺩﺭ ﻗﺎﻟﺐ ﺩﻭ ﺷﻴﻮﻩ ﺍﺭﺯﻳﺎﺑﻲ ﺷﺪﺕ ﭼﺴﺒﻨﺪﮔﻲ ﻭ ﺩﺭﺻﺪ ﭼﺴﺒﻨﺪﮔﻲ ﺍﺭﺍﺋﻪ ﮔﺮﺩﻳﺪ ﻭ ﻧﺸﺎﻥ ﺍﺯ ﮐﺎﻫﺶ ﻣﻌﻨﺎﺩﺍﺭ )P<0.05( ﭼﺴﺒﻨﺪﮔﻲ ﺩﺭ ﮔﺮﻭﻩ ﻧﺮﻣﺎﻝ ﺳﺎﻟﻴﻦ ﺩﺍﺷﺖ. ﻫﻤﭽﻨﻴﻦ ﺑﺮﺭﺳﻲ ﻫﺎﻱ ﭘﺎﺗﻮﻟﻮﮊﻳﮏ ﮐﺎﻫﺶ ﻣﻌﻨﺎﺩﺍﺭ )05.P<0( ﺷﺎﺧﺺ ﻫﺎﻱ ﭘﺎﺗﻮﻟﻮﮊﻳﮏ ﭼﺴﺒﻨﺪﮔﻲ ﺩﺭ ﮔﺮﻭﻩ ﻧﺮﻣﺎﻝ ﺳﺎﻟﻴﻦ ﺭﺍ ﻣﺸﺨﺺ ﮐﺮﺩ.ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺍﺳﺘﻔـﺎﺩﻩ ﺍﺯ ﻧﺮﻣـﺎﻝ ﺳﺎﻟﻴـﻦ ﭘﺲ ﺍﺯ ﺍﻋﻤـﺎﻝ ﺟـﺮﺍﺣﻲ ﺷﮑﻤـﻲ، ﺩﺭ ﺟﻠﻮﮔﻴـﺮﻱ ﺍﺯ ﺍﻳﺠـﺎﺩ ﭼﺴﺒﻨﺪﮔﻲ ﺩﺭ ﻧﺎﺣﻴﻪ ﺷﮑﻤﻲ ﻣﺆﺛﺮ ﺍﺳﺖ.

Introduction & Objective: Adhesion formation after abdominal surgery is a major cause of postoperative bowel obstruction, infertility, and chronic abdominal pain. In this study, we evaluated the effect of normal saline on postoperative adhesion formation in a rat model. Materials & Methods: A total of 30 Wistar female rats were randomly divided in 3 groups involving Normal saline (NS) group, Control group and a group of normal animals (not include in our study). Under general anesthesia, and following a 3cm midline incision, the anterior surface of serous membrane in the rat was scraped slightly. One ml of Normal saline was administrated intraperitoneally in the NS group. The duration from opening to the beginning of the closure was 1 min. In the control group, no medication was administered, and only cecum was exposed to air for 1 min. Fourteen days after the surgery, a re-laparotomy was performed for macroscopic and pathological assessment and then all of them were destroyed. A comparison of the groups was carried out using the non-parametric Kruskal-Wallis test, followed by Mann- Whitney U statistics, to detect the statistically significant differences among the groups. Analysis was performed using SPSS 13. P-value ≤ 0.05 was considered significant. Results: The adhesion grade and extent of the normal saline group was lower than those of control group in macroscopic assessment (P<0.05). A comparison of the adhesion stages in pathological assessment showed a reduction in the abdominal adhesion by the usage of NS, and demonstrated a significant difference between Normal saline and control groups (P<0.05). Conclusions: Administrating normal saline has preventive effects on the postoperative abdominal adhesion.