The Research Of Integrated Prevention And Treatment By Stages In Peritoneal Adhesion

Objective Peritoneal adhesion is one of the common complications postoperatively and its incidence is above 90%. Among those sufferings, more than 80% get adhesion between wounds and epiploon, 50% involve intestines. With resulting in chronic abdominal pain, women infertility, etc. Some researchs reveal that trauma, inflammation and foreign body are mostly factors in peritoneal adhesion, but the influence degree and mechanism are not clear. This experiment expect to understand the mechanism and the dynamic state process of peritoneal adhesion though creating the wound, wound and inflammation the animal model. Methods 240 healthy Wistar rats were randomly divided into three groups with eithty animals in each group, each sex in a half respectively. The surgeries on them were different among the different groups: Group A(Trauma group), intestines were clamped to establish an abacterial traumatic model; Group B(Taruma+Infection group), the procedures made were the same as those in Group A besides coliform were puted into peritoneal cavity; Groop C(Normal control group), without any treatments. Rats in all the above groups were randomly divided into four groups, which were killed at 1 day, 3 day, 7 day, 14 day, postoperatively in turn to observe their status of peritoneal adhesion. The adhesion tissues were taken to dye in HE and the blood samples to measure the contents of TPA, PAI and FDP. All the data available were analysed with Ridit analysis. Results Adhesion status were the most severe in Group B.The degree of adhesion status decreased in the following turn: Group B >Group A> Group C . With HE dying it suggested that macrophages and blastofibriocyte increased, mesothelial cell decreased in the specimen of severe adhesion animals, while the opposite phenomena occurred in the specimen of mild adhesion animals. What were seen in the blood samples was similar to those in the tissue samples. The content in blood of TNF, TGF-β, PAI increased in the severe adhesion animals. On contrary, it was t-PA that increased in the blood sample of the mild adhesion animals. Conclusion Peritoneal infection , inflammation and peritoneum harms are important start factors that on peritoneal adhesion, while adjacent peritoneum harms are spatially foundation. The exudation of the fiber of earlier period provide important" framework" for fibroblasts propagating and ultimately organified. It is necessary in preventing peritoneal adhesion that controlling infection, treating inflammation respond, reducing the peritoneum harm of adjacent part, early promoting fibrinolysis, accelerating mesothelial cell repaired, restrain fibroblasts proliferation.Objective During the peri toneal adhension , it was existing in belly cavity of the process of the infection and inflammation, fiber leaking out, the fiber basement formation and become the fibroblasts migration. Sequencable treatment by early controlling infection, restraining inflammation respond, promoting fibrinolysis, accelerating mesothelial cell repaired, inhibitting fibroblasts proliferation possibly modulat peritoneal adhesion though multiple aspect. This research choice rhubarb, dahurian dahurian patriniae herb herb, dan-shen root, sub-shrubby peony root-bark and spina gleditsiae to discuss significance of preventing peritoneal adhesion. Methods 60 healthy Wistar rats were randomly divided into three groups with twenty animals in each group. The surgeries on them were different among the different groups: Group A (Taruma +Infection group), as paper one; Group B(Taruma+Infection+Chinese herbs group), the procedures made were the same as those in Group A besides rhubarb and dahurian patriniae herb were perfused into stomaches after 12 hours, then after 72 hours, dan-shen root, sub-shrubby peony root-bark and spina gleditsiae were given into stomaches 4ml per day; Groop C(Normal control group), without any treatments. Rats were killed at 7th day, postoperatively in turn to observe their status of peritoneal adhesion. The adhesion tissues were taken to dye in HE. All the data,available were analysed with Ridit analysis. Results The degree of adhesion status decreased in the following turn: Group C >Group B> Group A. Conclusion Sequencable treatment the Chinese herbal can firmly reduced the occurrence and degree of peritoneal adhension. The sequencable treatment of the Chinese herbal can definitely reduce the occurrence and degree of peritoneal adhesion. Its possible mechanism includes the earlier period of Chinese traditional medicine anti-virus, eliminate inflammation, increase the bowel peristalsis, and following increase the activity of the plasminogen , promoting fibrinolysis and restrain fibroblasts proliferation et al. The study of orthogonal design with Chinese herbal on regulating fibrinolysis in procession of peritoneal adhesion in ratsObjective Infection, inflammation, mesothelial cell harm, the fiber leaking out, fibroblasts excessive proliferation is the formative pathophysiological foundation of adhesion, but each aspect mutually link of the connection. The sequencable treatment of the Chinese herbal can definitely reduce the occurrence and degree of peritoneal adhesion. On this foundation, this research use orthogonal design to primarily analyzing the function of the Chinese herbalto the procession of fibrinolysis. Methods 960 healthy Wistar rats were randomly divided into Trauma group (Group A) and Taruma+Infection group (Group B),the procedures made were the same as those in paper one. According to table of orthogonal design L16(215), the rats were respectively divided into sixteen groups with ten animals in each group. The A, B, C,D,E represents rhubarb, dahurian patriniae herb, dan-shen root, sub-shrubby peony root-bark and spina gleditsiae, one level for not give medicine,2 levels for whole medicine Rats in all the above groups were killed at 1 day, 3 day, 7 day, postoperatively taken the blood samples to measure the contents of TPA, PAI and FDP. Results In the A group, dahurian patriniae herb and sub-shrubby peony root-bark can increase the level of t-PA which both of them could fold each other after 24 hours, 3th day and 7th day of the operation. For the PAI, Chinese traditional medicine did not lower the function after 24 hours, but rhubarb, dahurian patriniae herb and spina gleditsiae can do it after 24 hours, 3th day and 7th day of the operation. Spina gleditsiae, dan-shen root and sub-shrubby peony root-bark can increase the level of FDP after 24 hours, 3th day and 7th day of the operation, while Spina gleditsiae and sub-shrubby peony root-bark could fold each other. In B group, spina gleditsiae and dan-shen root can increase the level of t-PA after 24 hours, 3th day and 7th day of the operation. For the PAI, rhubarb and dahurian patriniae herb can lower it after 24 hours, 3th day and 7th day of the operation. For the FDP, dan-shen root is main factors. Conclusion Dan-shen root and spina gleditsiae can increase the level of t-PA which both of them could fold each other after 24 hours, 3th day and 7th day of the operation. The level of PAI is decreased by early using Rhubarb and dahurian patriniae herb, at the same time, associated with rhubarb and dan-shen root, dan-shen root and spina gleditsiae, sub-shrubby peony root-bark and spina gleditsiae also have the certain treatment meaning in the in the middle and late times of the operation. Along with the variety of the t-PA and the PAI, fibrin is gradually dissolved, while FDP increase simultaneously. Dan-shen root and spina gleditsiae are the main factors, which can fold each other. The le"el of t-PA is as same as the rerult of FDP. It can inferred that the increasing of t-PA is one of the main mechanisms for fibrinolysis, whlie dan-shen root and spina gleditsiae can partially regulate this process. The cytological modulatory mechanism of Chinese traditional medicine onperitoneal adhesionObjective Rhubarb, dahurian patriniae herb, dan-shen root, sub-shrubby peony root-bark and spina gleditsiae could effectively modulate the inflammatory reaction, fibrinolysis process, mesothelial cell' s repair activityand fibroblast' s function, thus decreasing the occurrence of peritoneal adhesion. Through culture in vitro, we study the aboved modulatory mechanism of Chinese traditional medicine on macrophage, fibroblast and mesothelial cell. Methods 20 male Wistar rats were randomly divided into 3 groups for different cell culture, then subdivided into 6 subgroups for different Chinese traditional medicine administration. Biomarkers such as TNF, IL-6, PAI and t-PA were measured, the proliferation rate of mesothelial cells and fibroblasts were analyzed. Results The A group hve not statistics meaning in the TNF examination, while matched controlgroups , the B1 group and B2 groups hve statistics meaning. Matched control group, the A1 to A5 group and hve statistics meanin in the I L-1 examination. Normal group, C3, C2, C5, D3, D2, D1, E2 and E3 group also hve statistics meaning to control group in the examination of fibroblasts proliferation. In the examination of mesothelial cell proliferation, three group of normal and control hve statistics meaning; F3, G3, G2, G1, G4, H3, H4 group hve statistics meaning to control group. A3 to A5 group , B2 to B5 group group hve statistics meaning to control group in the examination of t~PA of macrophage. In the examination of.t-PA of mesothelial cell, normal group, F3, F5, G3, G5, H3, H4, H5 group hve statistics meaning to control group. A group has no statistics meaning in the examination of PAI of macrophage, while Bl to B5 group has statistics meaning to control group. In the examination of PAI of mesothelial cell, normal group, F1, F2, G1, G2, G3, H2, H1 and H3 group hve statistics meaning to control group. Conclusions Macrophage, mesothelial cell and fibroblast all participate in the process of inflammation, fibrin deposition, fibrinolysis, fibrosis and chorion repairing. Macrophage was activated by infection, then secreted inflammatory factors and PAI, thus inducing peritoneal adhesion; rhubarb and dahurian patriniae herb could downregulate the secreting activity of macrophage; dan-shen root and sub-shrubby peony root-bark could partially increase t-PA' s secretive activity. The stimulation of infection, inflammation, TNF and cytokines promote the proliferation of fibroblast, making li one of the dominating cells in adhesion development and fibrosis. dahurian patriniae herb, dan-shen root, sub-shrubby peony root-bark and spina gleditsiae could directly suppress the activation and proliferation of fibroblast, while rhubarb could inhibit the induction of bacterial endotoxin for fibroblast proliferation. Local inflammation might lead to peritoneal adhesion through the suppression of mesothelial cell' s activity, while dan-shen root and sub-shrubby peony root-bark could upregulate the proliferation activity of mesothelial cell, thus accelerating the early repair of peritoneum. Combined with dan-shen root and spina gleditsiae or rhubarb and dahurian patriniae herb, these Chinese traditional medicine might upregulate the secretive activity of t-PA and downregulate PAI' s secretive activity, thus becoming an important part in fibrolysis suppression.Objective The high incidence and difficult therapy of peritoneal adhesion make the disease a medical problem. We' ve understood the process and the influencing factors of the disease and successfully reduced the occurrence and progression through Chinese traditional medicine. If these findings could apply to clinical work, the reduction of postoperative peritoneal adhesion may become a reality. As laparoscopy technique has been widely applied and been considered associating with the prevention of adhesion, we gave children suffering from chronic abdominal pain with intestinal obstruction history different treatments, trying to approve the possibility of prevention and treatment of peritoneal adhesion. Methods 39 children with chronic abdominal pain were randomly divided into traditional operation group and laparoscopy with Chinese traditional medicine group. PAI, t-PA were measured and postoperative gurgling sound recovering time, exsufflation time, defecation time, inhospital duration were analyzed. Follow-up were carried out for the observation of adhesive abdominal pain. Results Children in laparoscopy group showed lower level of t-PA and higher level of PAI 24hs after operation. 36hs later, both t~PA and PAI levels in laparoscopy group returned to preoperative levels. 48hs after operation, both markers showed no changes in laparoscopy group. Postoperative gurgling sound recovering time, exsufflation time, defecation time and inhospital duration were shorter in laparoscopy group. Conclusions Laparoscopy could reduce trauma, lighten intra-abdominal inflammation, accelerate the recovery of intestinal function, compart the cut and operation part and decreased the development of strap. Based on laparoscopy, Chinese traditional medicine such as dan-shen root, sub-shrubby peony root-bark, and spina gleditsiae could promote chorion repair, regulate fibrinolysis, control fibroblast proliferation, further favor the prevention of peritoneal adhesion. The Clinical study of Laparoscopy, combined with Chinese traditional medicine in integrative prevention of postoperative peritoneal adhesion withsuppurative peritonitisObjective The development of peritoneal adhesion underwent intra-abdominal infection, lesion, inflammation to fibrin effusion, matrix formation to fibroblast proliferation, migration and fibrosis. Rhubarb, dahurian patriniae herb, dan-shen root, sub-shrubby peony root-bark and spina gleditsiae...