Phospholipide reduzieren Adhäsionen im Uterus-Horn-Modell beim Kaninchen
Background. Adhesion formation following gynecologic or visceral surgery is a major cause of female infertility. Further sequelae are recurrent and chronic abdominal complaints and pain. Adjuvant therapy is needed to prevent adhesion formation as an important reason for postoperative morbidity and mortality. Previously published data proved the efficacy of phospholipids (PL) for this indication. This study was designed to access the ability of intraperitoneal phospholipids to reduce adhesions in a standardized model for gynecologic operations. Materials and Methods: A total of 33 female Chinchilla rabbits were included in this study. After lower midline incision a 5 cm segment the uterine horns were abraded circularly and ischemia was induced by removal of the collateral blood supply. The operation was completed by intraperitoneal administration of 5.0 ml per kg body weight of phospholipids (75 mg per kg body weight) or the same volume of Ringer‘s lactate solution. In animals assigned to the surgical control group, the abdomen was closed without additional treatment. After 10 days the animals were sacrificed and adhesions were examined and scored concerning severity and tenacity. The force of adhesions measuring larger than 25 mm2 were assessed using a spring scale (values in Newton). After subtle dissection the areas of adhesions (mm2) were measured using a digitizer board and a custom-made software on a personal computer. Results: The mean area of adhesions in the surgical control group amounted to 394.0 mm2 ±41.9 mm2 (median 392.2 mm2) in comparison to 384.2 ± 67.0 mm2 (median 323.8 mm2) in the Ringer group and 110.3 mm2 ±25.1 mm2 (median 102.1mm2) in the phospholipid (PL) group. The comparison of the control group and the Ringer group versus the PL group were significant (p < 0.05). The differences in the severity score and the degree score according to Leach between surgical controls and PL as well as Ringer and PL were significant (p < 0.05). The differences of the force to tear apart the adhesions were significant (p < 0.05). Statistical analysis of the force correlated with the area of the measured adhesions revealed no significant difference. Conclusions: These results prove the efficacy of phospholipids in the double uterine horn model. Further clinical studies are recommended.
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