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World J Gastroenterol. Feb 28, 2007; 13(8): 1262-1267
Published online Feb 28, 2007. doi: 10.3748/wjg.v13.i8.1262
Preventive effect of gelatinizedly-modified chitosan film on peritoneal adhesion of different types
Xie-Lai Zhou, Shan-Wen Chen, Guo-Dong Liao, Zhou-Jun Shen, Zhi-Liang Zhang, Li Sun, Yi-Jun Yu, Qiao-Ling Hu, Xiao-Dong Jin
Xie-Lai Zhou, Shan-Wen Chen, Guo-Dong Liao, Xiao-Dong Jin, Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Zhou-Jun Shen, Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
Xie-Lai Zhou, Zhi-Liang Zhang, Yi-Jun Yu, Surgical Department, Clinical Medical College of Hangzhou Teachers College, Hangzhou 310036, Zhejiang Province, China
Li Sun, Experimental Center of Medical Science, Hangzhou Teachers College, Hangzhou 310036, Zhejiang Province, China
Qiao-Ling Hu, Institute of Polymer Composites, Zhejiang University, Hangzhou 310027, Zhejiang Province, China
Author contributions: All authors contributed equally to the work.
Supported by The National Natural Science Foundation of China, No. 50173023
Correspondence to: Xiao-Dong Jin, Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China. addamm@mail.hz.zj.cn
Telephone: +86-571-87236833 Fax: +86-571-87236628
Received: December 21, 2006
Revised: January 2, 2006
Accepted: January 31, 2007
Published online: February 28, 2007
Abstract

AIM: To comparatively study the preventive effect of gelatinizedly-modified chitosan film on peritoneal adhesions induced by four different factors in rats.

METHODS: Chitosan was chemically modified by gelatinization, and made into films of 60 μm in thickness, and sterilized. Two hundred Sprague-Dawley rats were randomly divided into five groups, Sham-operation group (group A), wound-induced adhesion group (group B), purified talc-induced adhesion group (group C), vascular ligation-induced adhesion group (group D), and infection-induced adhesion group (group E), respectively. In each group, the rats were treated with different adhesion-inducing methods at the cecum of vermiform processes and then were divided into control and experimental subgroups. Serous membrane surface of vermiform processes were covered with the films in the experimental subgroups, and no films were used in the control subgroups. After 2 and 4 wk of treatments, the abdominal cavities were reopened and the adhesive severity was graded blindly according to Bhatia’s method. The cecum of vermiform processes were resected for hydroxyproline (OHP) measurement and pathological examination.

RESULTS: Adhesion severity and OHP level: After 2 and 4 wk of the treatments, in the experimental subgroups, the adhesions were significantly lighter and the OHP levels were significantly lower than those of the control subgroups in group B (2 wk: 0.199 ± 0.026 vs 0.285 ± 0.041 μg/mg pr, P < 0.001; 4 wk: 0.183 ± 0.034 vs 0.276 ± 0.03 μg/mg pr, P < 0.001), D (2 wk: 0.216 ± 0.036 vs 0.274 ± 0.040 μg/mg pr, P = 0.004; 4 wk: 0.211 ± 0.044 vs 0.281 ± 0.047 μg/mg pr, P = 0.003) and E (2 wk: 0.259 ± 0.039 vs 0.371 ± 0.040 μg/mg pr, P < 0.001; 4 wk: 0.242 ± 0.045 vs 0.355 ± 0.029 μg/mg pr, P < 0.001), but there were no significant differences in groups A (2wk: 0.141 ± 0.028 vs 0.137 ± 0.026 μg/mg pr, P = 0.737; 4 wk: 0.132 ± 0.031 vs 0.150 ± 0.035 μg/mg pr, P = 0.225) and C (2 wk: 0.395 ± 0.044 vs 0.378 ± 0.043 μg/mg pr, P = 0.387; 4 wk: 0.370 ± 0.032 vs 0.367 ± 0.041 μg/mg pr, P = 0.853); Pathological changes: In group B, the main pathological changes were fibroplasias in the treated serous membrane surface and in group D, the fibroplasia was shown in the whole layer of the vermiform processes. In group E, the main pathological changes were acute and chronic suppurative inflammatory reactions. These changes were lighter in the experimental subgroups than those in the control subgroups in the three groups. In group C, the main changes were foreign body giant cell and granuloma reactions and fibroplasias in different degrees, with no apparent differences between the experimental and control subgroups.

CONCLUSION: The gelatinizedly-modified chitosan film is effective on preventing peritoneal adhesions induced by wound, ischemia and infection, but the effect is not apparent in foreign body-induced adhesion.

Keywords: Chitosan; Gelatinization; Chemical modification; Peritoneum; Adhesion