Prevenção de aderências pélvicas: estudo experimental em ratas com diferentes modalidades terapêuticas
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Data
2003-06-01
Autores
Pacheco, José Fernando [UNESP]
Dias, Rogerio [UNESP]
Silva, Marcia Guimarães da [UNESP]
Tristão, Andréa da Rocha [UNESP]
De Luca, Laurival Antônio [UNESP]
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Editor
Federação Brasileira das Sociedades de Ginecologia e Obstetrícia
Resumo
OBJETIVOS: avaliar o grau de aderências pélvicas em função do tempo e da utilização de diferentes substâncias empregadas na sua profilaxia. MATERIAL E MÉTODOS: estudo prospectivo com 120 ratas Wistar, albinas, virgens, 3 a 4 meses de idade, pesando aproximadamente 250 gramas, divididas aleatoriamente em 10 grupos de 12 animais cada: controle, sem lesão; lesões e sem tratamento; lesões + solução fisiológica 0,9%; lesões + Ringer-lactato; lesões + dextrano 70 a 32%; lesões + Ringer-lactato/heparina; lesões + Ringer-lactato/dexametasona; lesões + Ringer-lactato/hidrocortisona/dexametasona/ampicilina; lesões + Ringer-lactato/albumina e lesões + carboximetilcelulose 1%. Após anestesiados os animais, realizaram-se dois tipos de lesões nos cornos uterinos (escarificação e eletrocauterização), seguidos de tratamento profilático intraperitoneal com as soluções citadas. No 7º, 14º e 28º dia pós-operatório, momentos M1, M2 e M3, respectivamente, avaliaram-se quatro ratas de cada grupo quanto à presença de aderências. Os métodos empregados na quantificação das aderências encontradas basearam-se na classificação de Cohen, com escores variando de 0 a 4+ de acordo com a quantidade, características e localização das aderências. Foram usadas provas paramétricas para análise da variância e Kruskal-Wallis. RESULTADOS: os melhores tratamentos para prevenção de aderência pélvica em ratas foram: Ringer-lactato/dexametasona (predomínio do escore 1+), dextrano 70 a 32% (predomínio do escore 2+) e Ringer-lactato/hidrocortisona/dexametasona/ampicilina (predomínio do escore 2+). O período pós-operatório, representado pelo momento M3, e a técnica cirúrgica, predominantemente com escore 0, influíram na adesiólise e manutenção de aderências pélvicas em ratas. CONCLUSÕES: a prevenção de aderências pélvicas em ratas inicia-se no processo cirúrgico de baixo dano tecidual; o uso de substâncias profiláticas (soluções) tem eficácia variada, sendo que algumas mostraram-se mais eficazes que outras.
PURPOSE: to evaluate the degree of pelvic adhesions in function of time and the different substances used in its prophylaxis. MATERIAL and METHODS: prospective study with 120 female, albino, virgin Wistar rats, 3 to 4 months of age, weighing approximately 250 g, randomly divided into 10 groups of 12 animals each: control, without lesion; lesions and without treatment; lesions + 0.9% physiologic saline, lesions + Ringer lactate; lesions + 32% dextran 70; lesions + Ringer lactate/heparin; lesions + Ringer lactate/dexamethasone; lesions + Ringer lactate/hydrocortisone/dexamethasone/ampicillin; lesions + Ringer lactate/albumin, and lesions + 1% carboxymethylcellulose. The animals were anesthetized and two types of lesions (scarification and electrocauterization) were performed in the uterine horns, followed by treatment with the solutions, intraperitoneally, to prevent pelvic adhesions. on the 7th, 14th and 28th postoperative days, moments M1, M2 and M3, respectively, the presence of adhesions was evaluated in 4 rats of each group. The methods applied to the quantification of the adhesions were based on Cohen's classification, with scores varying from 0 to 4+ according to the amount, characteristics and location of the adhesions. Statistical analysis was performed by parametric tests for analysis of variance and the Kruskal-Wallis test. RESULTS: the best treatments for prevention of pelvic adhesions in female rats were Ringer lactate/dexamethasone (score 1+ prevalence), 32% dextran 70 to (score 2+ prevalence) and Ringer lactate/hydrocortisone/dexamethasone/ampicillin (score 2+ prevalence). The postoperative period, represented by moment M3, and the surgical technique, predominantly with score 0, influenced adhesiolysis and maintenance of pelvic adhesions in female rats. CONCLUSIONS: the prevention of pelvic adhesions in female rats begins with the surgical process at a smaller extent of tissue damage. The use of prophylactic substances (solutions) had a varied effectiveness, since some were more efficient than others.
PURPOSE: to evaluate the degree of pelvic adhesions in function of time and the different substances used in its prophylaxis. MATERIAL and METHODS: prospective study with 120 female, albino, virgin Wistar rats, 3 to 4 months of age, weighing approximately 250 g, randomly divided into 10 groups of 12 animals each: control, without lesion; lesions and without treatment; lesions + 0.9% physiologic saline, lesions + Ringer lactate; lesions + 32% dextran 70; lesions + Ringer lactate/heparin; lesions + Ringer lactate/dexamethasone; lesions + Ringer lactate/hydrocortisone/dexamethasone/ampicillin; lesions + Ringer lactate/albumin, and lesions + 1% carboxymethylcellulose. The animals were anesthetized and two types of lesions (scarification and electrocauterization) were performed in the uterine horns, followed by treatment with the solutions, intraperitoneally, to prevent pelvic adhesions. on the 7th, 14th and 28th postoperative days, moments M1, M2 and M3, respectively, the presence of adhesions was evaluated in 4 rats of each group. The methods applied to the quantification of the adhesions were based on Cohen's classification, with scores varying from 0 to 4+ according to the amount, characteristics and location of the adhesions. Statistical analysis was performed by parametric tests for analysis of variance and the Kruskal-Wallis test. RESULTS: the best treatments for prevention of pelvic adhesions in female rats were Ringer lactate/dexamethasone (score 1+ prevalence), 32% dextran 70 to (score 2+ prevalence) and Ringer lactate/hydrocortisone/dexamethasone/ampicillin (score 2+ prevalence). The postoperative period, represented by moment M3, and the surgical technique, predominantly with score 0, influenced adhesiolysis and maintenance of pelvic adhesions in female rats. CONCLUSIONS: the prevention of pelvic adhesions in female rats begins with the surgical process at a smaller extent of tissue damage. The use of prophylactic substances (solutions) had a varied effectiveness, since some were more efficient than others.
Descrição
Palavras-chave
Cirurgia experimental, Aderências pélvicas, Complicações da cirurgia, Experimental surgery, Pelvic adhesions, Complications of surgery
Como citar
Revista Brasileira de Ginecologia e Obstetrícia. Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, v. 25, n. 5, p. 359-364, 2003.