بررسي تأثير مايع آمنيوتيك در جلوگيري از چسبندگي داخل شكمي پس از لاپاراتومي در موش صحرائي

Effects of Amniotic Fluid in Prevention of Abdominal Adhesion after Laparatomy in Rat Models

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﻣﺎﻳﻊ ﺁﻣﻨﻴﻮﺗﻴﻚ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺩﺍﺭﺍ ﺑﻮﺩﻥ ﺍﺳﻴﺪ ﻫﻴﺎﻟﻮﺭﻭﻧﻴﻚ4 ﻛﻪ ﻋﺎﻣﻠﻲ ﺩﺭ ﺑﻬﺒﻮﺩ ﻭ ﺗﺮﻣﻴﻢ ﺯﺧﻢ ﺩﺭ ﺟﻨﻴﻦ ﺍﺳﺖ، ﺑﻪ ﻧﻈﺮ ﻣﻲ ﺭﺳﺪ ﻛﻪ ﻣﻲ ﺗﻮﺍﻧﺪ ﺩﺭ ﻛﺎﻫﺶ ﭼﺴﺒﻨﺪﮔﻲ ﻣﺆﺛﺮ ﺑﺎﺷﺪ. ﻫﺪﻑ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺗﻌﻴﻴﻦ ﺗﺄﺛﻴﺮ ﻣﺎﻳﻊ ﺁﻣﻨﻴﻮﺗﻴﻚ ﺩﺭ ﺟﻠﻮﮔﻴﺮﻱ ﺍﺯ ﭼﺴﺒﻨﺪﮔﻲ ﺩﺍﺧﻞ ﺷﻜﻤﻲ ﭘﺲ ﺍﺯ ﻻﭘﺎﺭﺍﺗﻮﻣﻲ ﺩﺭ ﻣﻮﺵ ﺻﺤﺮﺍﺋﻲ ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ، 30 ﻋﺪﺩ ﻣﻮﺵ ﺻﺤﺮﺍﺋﻲ )Rat( ﻣﺬﻛﺮ ﺑﻪ ﻭﺯﻥ ﺗﻘﺮﻳﺒﻲ 20 + 220 GR، ﺑﻪ ﺻﻮﺭﺕ ﺗﺼﺎدﻓﻲ ﺑﻪ ﺩﻭ ﮔﺮﻭﻩ ﻣﺴﺎﻭﻱ 15 ﺗﺎﻳﻲ ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ. ﭘﺲ ﺍﺯ ﺑﺎﺯ ﻛﺮﺩﻥ ﺟﺪﺍﺭ ﺷﻜﻢ ﺑﺎ ﺷﻜﺎﻑ، ﺧﻂ ﻭﺳﻂ ﺭﻭﻱ ﭘﺮﻳﺘﻮﺋﻦ ﻗﺴﻤﺖ ﺭﺍﺳﺖ ﺷﻜﻢ ﺣﺪﻭﺩ 10 ﺷﻜﺎﻑ ﻃﻮﻟﻲ ﺑﻪ ﻃﻮﻝ ﺣﺪﻭﺩ 3 -2 ﺳﺎﻧﺘﻴﻤﺘﺮ ﺍﻳﺠﺎﺩ ﺷﺪﻩ ﻭ ﺍﺯ ﻗﺴﻤﺖ ﭼﭗ ﭘﺮﻳﺘﻮﺋﻦ ﻧﻴﺰ ﻗﻄﻌﻪ ﺍﻱ ﺑﻪ ﺍﺑﻌﺎﺩ ﺗﻘﺮﻳﺒﻲ ﻳﻚ ﺩﺭ ﻳﻚ ﺳﺎﻧﺘﻴﻤﺘﺮ ﺑﺮﺩﺍﺷﺘﻪ ﺷﺪ. ﺩﺭ ﮔﺮﻭﻩ ﺍﻭﻝ ﻛﻪ ﮔﺮﻭﻩ ﻣﻮﺭﺩ ﺑﻮﺩﻧﺪ ﻗﺒﻞ ﺍﺯ ﺑﺴﺘﻦ ﺷﻜﻢ 5 ﺳﻲ ﺳﻲ ﻣﺎﻳﻊ ﺁﻣﻨﻴﻮﺗﻴﻚ ﺍﻧﺴﺎﻥ ﺩﺍﺧﻞ ﺷﻜﻢ ﺭﻳﺨﺘﻪ ﺷﺪ ﺩﺭ ﮔﺮﻭﻩ ﺩﻭﻡ ﻧﻴﺰ ﻛﻪ ﮔﺮﻭﻩ ﺷﺎﻫﺪ ﺑﻮﺩﻧﺪ، 5 ﺳﻲ ﺳﻲ ﻧﺮﻣﺎﻝ ﺳﺎﻟﻴﻦ ﻗﺒﻞ ﺍﺯ ﺑﺴﺘﻦ ﺷﻜﻢ ﺭﻳﺨﺘﻪ ﺷﺪ. ﺩﺭﺟﻪ ﺑﻨﺪﻱ ﻣﻴﺰﺍﻥ ﭼﺴﺒﻨﺪﮔﻲ ﺍﻳﺠﺎﺩ ﺷﺪﻩ ﺗﻮﺳﻂ ﻳﻚ ﻧﻔﺮ ﻛﻪ ﺑﻪ ﮔﺮﻭﻩ ﺑﻨﺪﻱ ﻣﻮﺵ ﻫﺎﻱ ﺻﺤﺮﺍﺋﻲ ﺁﮔﺎﻫﻲ ﻧﺪﺍﺷﺖ ﻭ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻣﻘﻴﺎﺱ Ahmet Canbaz ﺍﻧﺠﺎﻡ ﺷﺪ. ﺍﻃﻼﻋﺎﺕ ﺟﻤﻊ ﺁﻭﺭﻱ ﺷﺪ ﻭ P<0.05 ﻣﻌﻨﻲ ﺩﺍﺭ ﺗﻠﻘﻲ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺩﺭ ﻣﻘﺎﻳﺴﻪ ﺩﻭ ﮔـﺮﻭﻩ ﺷﺎﻫﺪ ﻭ ﻣـﻮﺭﺩ، ﻣﺸﺎﻫـﺪﻩ ﺷﺪ ﻛﻪ ﻣﻴـﺰﺍﻥ ﭼﺴﺒﻨﺪﮔﻲ ﺩﺭ ﮔﺮﻭﻩ ﻣـﻮﺭﺩ، ﺑﻪ ﻃﻮﺭ ﻣﻌﻨﻲ ﺩﺍﺭﻱ، ﻛﻤﺘﺮ ﺍﺯ ﮔـﺮﻭﻩ ﺷﺎﻫـﺪ ﺑﻮﺩ )P=0.008(. ﻣﻴﺎﻧﮕﻴﻦ ﺩﺭﺟﻪ ﭼﺴﺒﻨﺪﮔﻲ ﺩﺭ ﮔـﺮﻭﻩ ﻣـﻮﺭﺩ، 1/3 + 1/13 ﻭ ﺩﺭ ﮔﺮﻭﻩ ﺷﺎﻫﺪ 1/18 + 2/5 ﺑﻪ ﺩﺳﺖ ﺁﻣﺪﻩ ﺍﺳﺖ )P <0.05(. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﻣﺎﻳﻊ ﺁﻣﻨﻴﻮﺗﻴﻚ ﺍﻧﺴﺎﻥ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﺤﺘﻮﺍﻱ ﺍﺳﻴﺪ ﻫﻴﺎﻟﻮﺭﻭﻧﻴﻚ ﺁﻥ ﻭ ﻧﻘﺸﻲ ﻛﻪ ﺩﺭ ﺗﺮﻣﻴﻢ ﻭ ﺑﻬﺒﻮﺩ ﺯﺧﻢ ﻫﺎﻱ ﺟﻨﻴﻦ ﺩﺍﺭﺩ ﺩﺭ ﻛﺎﻫﺶ ﭼﺴﺒﻨﺪﮔﻲ ﺩﺍﺧﻞ ﺷﻜﻤﻲ ﭘﺲ ﺍﺯ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﻣﺆﺛﺮ ﻣﻲ ﺑﺎﺷﺪ.

Introduction & Objective: Many studies were done and designed to determine the pathophysiology and to find a way to reduce the formation of adhesion bands after laparatomy. The purpose of our study was to determine the effect of aminiotic fluid in prevention of post laparatomy adhesion formation in rat models. Materials & Methods: Our study was experimental and laboratory. Thirty adult male rat were used in this study, divided in to two equal groups randomly. We opened the abdominal wall, then 1 * 1 cm peritoneal layer was excised from the left abdominal wall and 10 longitudinal incision of 2 to 3 cm in length were made on the right parietal peritoneum after that we filled the abdomen of the rats of group I (case group) with 5 cc of amniotic fluid and filled the abdominal of the rats group II (control group) with 5 cc normal saline. Second laparatomy carried out 14 day after the first laparatomy and abdominal adhesion were scored in order to Ahmet Canbaz scale and analyzed with Mann – withney test; P< 0.05 was significant. Results: After analysis we saw a significant difference between two group (P=0.008). The average of adhesion score were 1.13 +1.3 in group I and 2.5 + 1.18 in group II (P<0.05). Conclusions: Our study showed that Aminiotic fluid is capable to reduce the formation of adhesion bands after laparatomy.