- 期刊
Interceed Barrier as a Pericardial Substitute – An Animal Experimental Result
使用Interceed Barrier作為心包膜替代物之實驗結果
摘要
開心手術後之心包膜與胸骨下黏連對需要接受再次手術(repeat operation)之病人會造成相當的危險性。這種手術後的黏連對心臟外科醫師言，也是極具挑戰的工作。故而如何使此黏連的發生率降低或使黏連之程度減輕一直也是科學家探索期以嘗試解決之重要課題之一。在過去的二十年裡，許多天然合成的物質被嘗試用來減少黏連的發生，但是由於各具缺點，故而研究仍需不斷的進行。 INTERCEED BARRIER是一種氧化再生纖維素(oxidized regenerated cellulose)之聚合物。理論上，其可在癒合的組織上產生一層保護膜，避免手術後黏連之發生，過去的許多實驗已證明INTERCEED BARRIER可以使手術後腹腔黏連之發生率減低。本文的主要目的在經由動物實驗的模型嘗試了解INTERCEED BARRIER對預防手術後心包膜黏連之效果。 經由實驗，我們可發現INTERCEED BARRIER確實可以減輕 手術後心包膜黏連的發生。在巨視上，INTERCEED BARRIER與肋膜(pleura)間僅發生輕微黏連，與心肌膜(epicardium)間僅發生輕微黏連，與心肌膜(epicardium)間亦只有輕微黏連。經過二週後INTERCEED BARRIER已為人體完全吸收，沒有異物(foreign body)殘存。在微視上，INTERCEED BARRIER僅造成心肌膜輕微纖維化(fibrosis)，對組織之剝離影響甚微。 由於上述實驗之結果，我們發現INTERCEED BARRIER有下列諸項優點：(一)可以避免手術後心包膜黏連之發生；(二)由於其為氧化再生纖維素，故不會有生理上之副作用，(三)可以在四週內完全被吸收，故沒有異物反應之發生；(四)由於沒有異物之存在故可以降低手術後之感染症。因此，我們認為INTERCEED BARRIER可以使用於預防手術後心包膜黏連發生，尤其是對有潛在發生感染症之患者，更可以考慮使用之。
關鍵字
無資料並列摘要
The risk in repeat operations resulting from postoperative adhesions is still a challenge to most cardiac surgeons. In attempt to reduce the pericardial adhesions, a lot of methods were tried in the past twenty years; however, the results were still unsatisfactory. In this paper, we tried to use Interceed barrier to minimize the adhesion and tissue reaction in animal experiments. The result was satisfactory. Gross appearance and pathological finding of the specimens revealed a mild to moderate adhesion between he pleura and Interceed barrier, and a minimal adhesion between he epicardium and Interceed barrier. Tissue reaction related to the insertion of Interceed barrier was rather minor, and was confirmed by microscopic examination. Besides that, Interceed barriers were completely absorbed within 4 weeks, which was a rather unique feature in comparison with other synthetic or xenogenous pericardial patches. From data demonstrated in this study, we concluded that Interceed barrier had at least 5 advantages: (1) Interceed barrier is an effective agent to prevent postoperative adhesions; (2) As a polymer composed of oxidized regenerated cellulose, Interceed barrier has no physiological adverse reaction or toxicity; (3) Because Interceed barrier can be completely absorbed within 4 weeks, no tissue reaction related to a foreign body occurs after that period; (4) The risk of infection associated with a foreign body is reduced; (5) The price of Interceed barrier is much lower than the price of other synthetic or xenogenous pericardial patches. Due to the merits mentioned above, we do recommend Interceed barrier to be the material of choice to attenuate pericardial adhesion, thus reducing the risk of dissection during reoperation.