ﺑﺮرﺳﯽ اﺛﺮﺑﺨﺸﯽ ﻫﯿﺎﻟﻮروﻧﺎت ﺳﺪﯾﻢ، روﻏﻦ ﮐﻨﺠﺪ، ﻋﺴﻞ و ﻧﺎﻧﻮذرات ﻧﻘﺮه در ﺟﻠﻮﮔﯿﺮي از ﺗﺸﮑﯿﻞ ﭼﺴﺒﻨﺪﮔﯽ ﭘﺲ از ﻋﻤﻞ ﺟﺮاﺣﯽ

Evaluation of the Effectiveness of Sodium Hyaluronate, Sesame Oil, Honey and Silver Nanoparticles in Preventing Postoperative Surgical Adhesion Formation

زﻣﯿﻨﻪ و ﻫﺪف: ﭼﺴﺒﻨﺪﮔﯽ ﺟﺮاﺣﯽ ﺑﻌﺪ از ﻋﻤﻞ ﯾﮏ ﻧﺘﯿﺠﻪ ﺷﺎﯾﻊ ﻧﺎﺷﯽ از ﺟﺮاﺣﯽ داﺧﻞ ﺻﻔﺎﻗﯽ اﺳﺖ ﮐﻪ ﻣﻤﮑﻦ اﺳﺖ ﻣﻨﺠﺮ ﺑﻪ ﻋﻮارض ﻣﺘﻌﺪدي ﻣﺎﻧﻨﺪ اﻧﺴﺪاد روده ﮐﻮﭼﮏ، درد ﺷﮑﻤﯽ ﻣﺰﻣﻦ و ﻧﺎﺑﺎروري در زﻧﺎن ﺷﻮد ﮐﻪ ﺗﺄﺛﯿﺮ ﻗﺎﺑﻞ ﺗﻮﺟﻬﯽ در ﻫﺰﯾﻨﻪﻫﺎي ﻣﺮاﻗﺒﺖﻫﺎي ﺑﻬﺪاﺷﺘﯽ دارد. ﺗﻼشﻫﺎي زﯾﺎدي ﺑﺮاي ﮐﺎﻫﺶ ﻣﯿﺰان ﭼﺴﺒﻨﺪﮔﯽ ﭘﺲ از ﺟﺮاﺣﯽ ﺑﺎ اﺳﺘﻔﺎده از ﻋﻮاﻣﻞ ﺿﺪ اﻟﺘﻬﺎﺑﯽ، ﻓﯿﺒﺮﯾﻨﻮﻟﯿﺘﯿﮏ، ﺿﺪ اﻧﻌﻘﺎد، ﻣﻮاﻧﻊ ﻣﮑﺎﻧﯿﮑﯽ و آﻧﺘﯽ ﺑﯿﻮﺗﯿﮏﻫﺎ اﻧﺠﺎم ﺷﺪه اﺳﺖ. ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪف ﺑﺮرﺳﯽ اﺛﺮﺑﺨﺸﯽ ﻫﯿﺎﻟﻮروﻧﺎت ﺳﺪﯾﻢ، روﻏﻦ ﮐﻨﺠﺪ، ﻋﺴﻞ و ﻧﺎﻧﻮذرات ﻧﻘﺮه در ﺟﻠﻮﮔﯿﺮي از ﺗﺸﮑﯿﻞ ﭼﺴﺒﻨﺪﮔﯽ ﺟﺮاﺣﯽ ﭘﺲ از ﻋﻤﻞ اﻧﺠﺎم ﺷﺪ. ﻣﻮاد و روش ﻫﺎ: ﺗﻌﺪاد 40 ﻣﻮش ﺻﺤﺮاﯾﯽ ﻧﺮ ﻧﮋاد وﯾﺴﺘﺎر ﺑﻪ ﺻﻮرت ﺗﺼﺎدﻓﯽ ﺑﻪ ﭘﻨﺞ ﮔﺮوه ﺗﻘﺴﯿﻢ ﺷﺪﻧﺪ ﺑﻪ اﯾﻦ ﺗﺮﺗﯿﺐ ﮐﻪ ﻫﺸﺖ ﻣﻮش ﺻﺤﺮاﯾﯽ در ﻫﺮ ﮔﺮوه ﺷﺎﻣﻞ ﮔﺮوه ﮐﻨﺘﺮل، ﻫﯿﺎﻟﻮروﻧﺎت، ﮐﻨﺠﺪ، ﻋﺴﻞ و ﻧﻘﺮه ﻗﺮار ﮔﺮﻓﺘﻨﺪ. آﻧﻬﺎ در دﻣﺎي 21 درﺟﻪ ﺳﺎﻧﺘﯿﮕﺮاد و رﻃﻮﺑﺖ 5 ± 60٪ ﻗﺮار ﮔﺮﻓﺘﻨﺪ و ﺗﺤﺖ ﺷﺮاﯾﻂ ﻓﻮق ﺑﻪ ﻣﺪت دو ﻫﻔﺘﻪ ﻧﮕﻬﺪاري ﺷﺪﻧﺪ و ﭘﺲ از ﮔﺬﺷﺖ دو ﻫﻔﺘﻪ، ﺣﯿﻮاﻧﺎت ﺗﺤﺖ ﻻﭘﺎراﺗﻮﻣﯽ ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﺑﺮاي ﺗﻌﯿﯿﻦ ﺷﺪت ﭼﺴﺒﻨﺪﮔﯽ ﺑﻪ وﺳﯿﻠﻪ دو ﺟﺮاح ﻣﺨﺘﻠﻒ ﺑﺮاﺳﺎس دو ﺳﯿﺴﺘﻢ ﻧﻤﺮهدﻫﯽ رﺗﺒﻪﺑﻨﺪي ﻣﺨﺘﻠﻒ ﺷﺎﻣﻞ ﻃﺒﻘﻪﺑﻨﺪي Nair و ﻣﻘﯿﺎس ﻧﻤﺮه ﭼﺴﺒﻨﺪﮔﯽ ﺗﺠﻤﻌﯽ ﻣﻮرد ارزﯾﺎﺑﯽ ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ آﻣﺎري ﺑﺎ اﺳﺘﻔﺎده از ﻧﺮم اﻓﺰار SPSS ﺑﺮاي وﯾﻨﺪوز، ﻧﺴﺨﻪ 20/0، Armonk ،IBM Corp.، ﻧﯿﻮﯾﻮرك، اﯾﺎﻻت ﻣﺘﺤﺪه آﻣﺮﯾﮑﺎ اﻧﺠﺎم ﺷﺪ. دادهﻫﺎي ﮐﻤﯽ و ﮐﯿﻔﯽ ﺑﻪ ﺗﺮﺗﯿﺐ ﺑﺎ اﺳﺘﻔﺎده از آزﻣﻮن Kruskal-Wallis و Mann-Withney U اﻧﺠﺎم ﺷﺪ. ﻣﻘﺪار اﺣﺘﻤﺎل ﮐﻤﺘﺮ از 0/05 ﻣﻌﻨﯽدار از ﻧﻈﺮ آﻣﺎري در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﻧﻤﺮات ﺷﺪت ﭼﺴﺒﻨﺪﮔﯽ در ﮔﺮوهﻫﺎي ﻫﯿﺎﻟﻮروﻧﺎت و ﮐﻨﺠﺪ ﺑﻪ ﻃﻮر ﻣﻌﻨﯽداري ﮐﻤﺘﺮ از ﮔﺮوه ﮐﻨﺘﺮل ﺑﺮاﺳﺎس ﻃﺒﻘﻪ ﺑﻨﺪي Nair ﺑﻮد )ﻣﻘﺎدﯾﺮ اﺣﺘﻤﺎل ﺑﻪ ﺗﺮﺗﯿﺐ = 0/021 و 0/025(، ﺑﺎ اﯾﻦ ﺣﺎل ﺑﺮاﺳﺎس ﻣﻘﯿﺎس ﻧﻤﺮه ﭼﺴﺒﻨﺪﮔﯽ ﺗﺠﻤﻌﯽ ﻓﻘﻂ ﻧﻤﺮه ﺷﺪت ﭼﺴﺒﻨﺪﮔﯽ در ﮔﺮوه ﻫﯿﺎﻟﻮروﻧﺎت ﺑﻪ ﻃﻮر ﻣﻌﻨﯽداري ﮐﻤﺘﺮ از ﮔﺮوه ﮐﻨﺘﺮل ﺑﻮد )ﻣﻘﺪار اﺣﺘﻤﺎل = 0/024(. در ﮔﺮوه ﻫﯿﺎﻟﻮروﻧﺎت ﺷﺪت ﭼﺴﺒﻨﺪﮔﯽ ﺑﻪ ﻣﯿﺰان 48 درﺻﺪ ﺑﺮ اﺳﺎس ﻣﻘﯿﺎس ﻧﻤﺮه ﭼﺴﺒﻨﺪﮔﯽ ﺗﺠﻤﻌﯽ ﮐﺎﻫﺶ ﯾﺎﻓﺖ. ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﺑﺮ اﺳﺎس ﯾﺎﻓﺘﻪﻫﺎي اﯾﻦ ﭘﮋوﻫﺶ ﻣﯽﺗﻮان ﻧﺘﯿﺠﻪ ﮔﺮﻓﺖ ﮐﻪ روﻏﻦ ﻫﯿﺎﻟﻮروﻧﺎت ﺳﺪﯾﻢ و روﻏﻦ ﮐﻨﺠﺪ ﻣﻤﮑﻦ اﺳﺖ در ﭘﯿﺸﮕﯿﺮي از ﭼﺴﺒﻨﺪﮔﯽ ﺟﺮاﺣﯽ ﺑﻌﺪ از ﻋﻤﻞ ﺟﺮاﺣﯽ داﺷﺘﻪ ﺑﺎﺷﺪ.

Introduction & Objective: Postoperative surgical adhesion is a common consequence of intraperitoneal surgery which may lead to several complications such as adhesive small bowel obstructions, chronic abdominopelvic pain, and female infertility making a significant adverse impact on health care costs. Many efforts have been made aiming to decrease the rate of postoperative surgical adhesion formation. We conducted the present experimental study aiming to evaluate the effectiveness of sodium hyaluronate, sesame oil, honey, and silver nanoparticles in preventing of postoperative surgical adhesion formation. Materials & Methods: Our study was conducted in Hamadan University of Medical Sciences, Hamadan, Iran during 2015 and 2016. Forty male Wistar rats were randomly assigned into five groups with eight rats in each group including control, hyaluronate, sesame, honey and silver groups. They were housed in 21°C temperature and 60% ± 5 humidity. After two weeks the animals underwent laparotomy and were evaluated by two different blinded surgeons for severity of adhesions based on the two different classification scoring systems including Nair classification and cumulative adhesion scoring scale. Statistical analyses were performed by using SPSS software (IBM SPSS Statistics for Windows, Version 20.0, IBM Corp., Armonk, NY, USA). Quantitative and qualitative data were analyzed using the Kruskal-Wallis and Mann-Whitney U test, respectively. Statistical significance was defined by (P < 0.05). Results: The scores of severity of adhesions in the hyaluronate and sesame groups were significantly lower than the control group based on the Nair classification (both P-values = 0.02), however based on the cumulative adhesion scoring scale just the score of severity of adhesions in the hyaluronate group was significantly lower than the control group (P-value = 0.02). In the hyaluronate group the severity of adhesions was decreased by 48% based on the cumulative adhesion scoring scale. Conclusions: Sodium hyaluronate and sesame oil may have a significant effect in preventing postoperative surgical adhesion formation.